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    • Rouviere’s Sulcus in the Era of Laparoscopic Cholecystectomy; New Anatomical Types, Surgical Impact, And Possible Circumstances That Can Turn It from a Good Servant into a Deceptive Guide.

    Tarek Abouzeid Osman Abouzeid
    Lecturer of General and Laparoscopic Surgery, Faculty of Medicine, Ain-Shams University

    Study design: case series. Background: The gallstones are as old as eternity. Laparoscopic cholecystectomy (LC) is now considered the gold standard therapeutic option for symptomatic cholelithiasis. Rouviere’s Sulcus (RS), as a surgical landmark, is not widely used. However, the surgical interest in the RS has increased in the recent years with the development of LC. It is a fissure running to the right of the porta hepatis between the right lobe and caudate process. It is the best anatomical landmark that could accurately determine the safe area of dissection during LC. The aim of this study is to focus the light on the RS, anatomical description, types, relation to the right portal pedicle, the surgical impact of all these data on the technique of LC, and the possible circumstances in which RS could be a deceptive guide. Material and Methods: 150 consecutive patients suffered from gallstone disease were included in this study database within a period from May 2015 to May 2016, scheduled for LC. RS was looked for during the posterior dissection, its frequency and type were documented. Results: RS was recognizable in 126 patients (84%), being either fully open in 52.6%, partially open in 6.66%, superficial in 19.3% and scar type 2.66%. I discovered 2 new types unmentioned in any previous research before (the triangular type and the pit type). Conclusion: RS is the only known extra-hepatic landmark, identifiable in 84% of the patients. If an imaginary line drawn along its axis to the porta hepatis, it determines the level ventral to which dissection is mostly safe. However, the major bile ducts may be brought ventral to the RS by either excessive upward traction of the gall bladder or by adhesions turning it into a deceptive guide. It represents the line of effacement between Segment V and Segment VI, which may have variable degrees of fusion resulting in variant types. The two new types will help in better understanding of the relation between it and the right portal pedicle. Keywords: Rouviere’s Sulcus, triangular type, pit type laparoscopic cholecystectomy, Anatomical landmarks.

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