Role of Rouviere's sulcus as anatomical landmark in laparoscopic cholecystectomy:a report of 750 cases

Objective To explore the role of Rouviere's sulcus as the anatomical landmark for the cystic duct in laparoscopic cholecystectomy.Methods The clinical data of 750 patients who underwent laparoscopic cholecystectomy operated by one beginner from October 2012 to March 2014 in the Affiliated Santai Hospital of North Sichuan Medical College were analyzed.The frequency of appearance of Rouviere's sulcus was recorded during operation, and the Rouviere's sulcus was used as the anatomical landmark for the cystic duct in laparoscopic cholecystectomy.Results Of the 750 patients, 705 had Rouviere's sulcus.There was no mortality during operation.Bile duct injury occurred in one case (0.13%) , whose Rouviere's sulcus was not seen during operation.Among the first 300 cases, the three- hole method was used in35 cases, and 30 cases (10%) were converted to open surgery.Among the succeeding 450 cases, the three- hole method was used in 387 cases, and 15 cases (3.3%) were converted to open surgery.Conclusion Rouviere's sulcus is an important anatomical landmark for the cystic duct.Its identification before Calot's triangle dissection may help in preventing the bile duct injury in laparoscopic cholecystectomy for beginners.It has great clinical significance and should be applied widely.