Conventional Method Of Dissection Versus Identification Of Rouviere’s Sulcus And Cystic Lymph Node As Safety Landmarks In Laparoscopic Cholecystectomy: A Comparative Study.
DOI:
https://doi.org/10.37506/zkv9zy77Keywords:
Rouviere’s sulcus, Calot’s Triangle, cystic node, CVS, laparoscopic cholecystectomy, bile duct injury.Abstract
Background: Laparoscopic Cholecystectomy (LC) is the Gold Standard procedure for symptomatic gallstones. With the development of laparoscopic procedure, surgical interest in the Rouviere’s sulcus and cystic lymph node in relation to the right portal pedicle and prevention of bile duct injury has increased recently. This prospective study aimed at safety landmarks for avoiding Bile Duct Injuries during surgery and reducing the number of intraoperative and postoperative complications in laparoscopic cholecystectomy. The aim of the study is to compare the frequency of bile duct injury in conventional method of dissection versus the frequency of bile duct injury by delineating rouviere’s sulcus and cystic lymph node as safety landmark in laparoscopic cholecystectomy. Material and Method: A comparative study was conducted on 60 patients of cholelithiasis who underwent laparoscopic cholecystectomy at our institution in two-year period. All patients were evaluated in terms of clinical, biochemical, haematological and ultrasonographic parameters and randomised in two groups. Patients were allocated group A and B depending upon Ticket picked by them. Group A patient: Rouviere’s sulcus and cystic lymph node was identified intraoperatively and an imaginary line (R4U) that passed from the sulcus across the base of segment 4 to the umbilical fissure drawn and cystic line is an imaginary line running through cystic lymph node and parallel to hepatoduodenal ligament was drawn and dissection superolateral to intersection of these lines along with achievement of CVS. Group B patients: Underwent conventional method of dissection (calot’s Triangle dissection with critical view of safety achievement). Patients were followed up after 7 days and assessment was done. Conclusion : the study concluded that before commencement of calot’s triangle dissection identification of Rouviere's sulcus [RS] and cystic lymph node of lund is an extra biliary, easily accessible and reliable anatomical land mark from where we can draw two imaginary line [R4U and cystic line] and dissection start above and lateral to intersection of these line and no injury was observed and one bile duct injury was noted during convention method of dissection. So it can help us as an additional safe reference point to avoid bile duct injury and dissection in safe area close to gall bladder in laparoscopic cholecystectomy.
References
Stinton LM, Myers RP, Shaffer EA. Epidemiology of gallstones. Gastroenterology Clinics. 2010 Jun 1;39(2):157-69.
Pesce A, Portale TR, Minutolo V, Scilletta R, Li Destri G, Puleo S. Bile duct injury during laparoscopic cholecystectomy without intraoperative cholangiography: a retrospective study on 1,100 selected patients. Digestive surgery. 2012;29(4):310-4.
Machado NO. Biliary complications postlaparoscopic cholecystectomy: mechanism, preventive measures, and approach to management: a review. Diagnostic and therapeutic endoscopy. 2011;2011.
Viste A, Horn A, Øvrebø K, Christensen B, Angelsen JH, Hoem D. Bile duct injuries following laparoscopic cholecystectomy. Scandinavian Journal of Surgery. 2015 Dec;104(4):233-7.
Felekouras E, Petrou A, Neofytou K, Moris D, Dimitrokallis N, Bramis K et al. Early or Delayed Intervention for Bile Duct Injuries following Laparoscopic Cholecystectomy? A Dilemma Looking for an Answer. Gastroenterol Res Pract. 2015;2015:104235.
Olsen D. Bile duct injuries during laparoscopic cholecystectomy. Surgical endoscopy. 1997 Feb;11:133-8.
Wang ZY, Xu F, Liu YD, Xu CG, Wu JL. Prevention of biliary duct injury in laparoscopic cholecystectomy using optical fiber illumination in common bile duct. Gastroenterology Research. 2010 Oct;3(5):207.
Zubair M, Habib LU, Memon FA, Mirza MR, Khan MA, Quraishy MS. Rouviere’s sulcus: a guide to safe dissection and laparoscopic cholecystectomy. Pak J Surg. 2009;25(2):119-21.
Dahmane R, Morjane A, Starc A. Anatomy and surgical relevance of Rouviere’s sulcus. The Scientific World Journal. 2013 Jan 1;2013.
Gans H, Study of anatomy of the intrahepatic structures and its repercussions of hepatic surgery [Ph.D. thesis], University of Nijmegen, Elsevier, Amsterdam, The Netherlands. 1955.
Reynaud BH, Coucoravas GO, Giuly JA. Basis to improve several hepatectomy techniques involving the surgical anatomy of incisura dextra of Gans. Surgery, Gynecol Obstet. 1991 Jun 1;172(6):490-2.
Stringer MD, Mirjalili SA. Eponyms in surgery and anatomy of the liver, bile ducts and pancreas. London: Royal Society of Medicine Press; 2009.
Ferzli G, Timoney M, Nazir S, Swedler D, Fingerhut A. Importance of the node of Calot in gallbladder neck dissection: an important landmark in the standardized approach to the laparoscopic cholecystectomy. J Laparoendosc Adv Sur Tech. 2015;25(1):28-32.
Berci G, Hunter J, Morgenstern L, Arregui M, Brunt M, Carroll B et al. Laparoscopic cholecystectomy: first, do no harm; second, take care of bile duct stones. Surg Endoscopy. 2013 ;27:1051-4.
Barrett M, Asbun HJ, Chien HL, Brunt LM, Telem DA. Bile duct injury and morbidity following cholecystectomy: a need for improvement. Surg Endoscop. 2018;32:1683-8.
Pucher PH, Brunt LM, Davies N, Linsk A, Munshi A et al. SAGES Safe Cholecystectomy Task Force. Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis. Surg Endoscop. 2018;32:2175-83.
Pathak R, Mittal L, Chouhan GM, Tripathi A. Rouviere’s Sulcus: A Guide to Safe Laparoscopic Cholecystectomy. Journal of Acute Care Surgery. 2023;13(1):10-2.
Greene B, Tsang M, Jayaraman S. The inferior boundary of dissection as a novel landmark for safe laparoscopic cholecystectomy. HPB. 2021;23(7):981-3.
Gupta V, Jain G. Safe laparoscopic cholecystectomy: Adoption of universal culture of safety in cholecystectomy. World J Gastrointestinal Surg. 2019;11(2):62.
Bajpayee P, NeeleshKanaskar PV, Manivikar PR. Significance of Rouviere’s Sulcus in Hepatobiliary Surgery: A Cadaveric study. Int J Anat Res. 2021;9(3.2):8074-78.
Basukala S, Thapa N, Tamang A, Shah KB, Rayamajhi BB, Ayer D et al. Rouviere's sulcus-An anatomical landmark for safe laparoscopic cholecystectomy: A cross-sectional study. Ann Med Surg. 2022;75:103404.
Downloads
Published
Issue
Section
License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
https://creativecommons.org/licenses/by-nc/2.0/deed.en