The anatomy of Rouviere's sulcus as seen during laparoscopic cholecystectomy: A proposed classification

Abstract

Introduction: Although Rouviere's sulcus is being increasingly mentioned as the first landmark to be seen so as to begin dissection during laparoscopic cholecystectomy to prevent bile duct injuries, the anatomy of the sulcus has not been described in clear and simple terms.

Objectives: To define the detailed anatomy of Rouviere sulcus as seen during laparoscopic surgery in simple terms for the surgeons to refer to and begin their dissection from this, always staying above this sulcus in order to eliminate bile duct injury.

Methods: 100 recordings of laparoscopic cholecystectomy were analysed to define the anatomy of the Rouviere's sulcus.

Results: Majority of the sulci (71) were seen as a deep sulcus and were labelled as simply the 'sulcus'. This was further seen to be of two types - open (60) or closed (11). Some of the sulci (23) were small and so narrow and shallow as to be labelled as a 'slit'. Rarely, the sulcus was found to be fused and represented by a white fusion line (6 cases), and this was simply labelled as a 'scar'.

Conclusions: The Rouviere's sulcus can now be defined in three simple terms - a deep sulcus, or a slit or a scar. We recommend that as a first step in laparoscopic cholecystectomy, the surgeon must look for this reference point (whether it is in the form of a scar, or a slit or a real sulcus) which will be the plane of the main bile duct, and thus avoid any dissection below this point in order to eliminate any danger to the bile duct during surgery.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1

Measuring the dimensions of the Rouviere's sulcus with a feeding tube marked in centimetre

Figure 2

The scar

Figure 3

The slit

Figure 4

The sulcus (open type)

Figure 5

The sulcus (closed type)