Rouviere's sulcus as a helpful anatomical landmark for safe laparoscopic cholecystectomy

Rouviere's sulcus (RS) is a horizontal anatomical structure that runs from the caudate process to the right hepatic lobe on the inferior face of the liver. This groove lies along the common bile duct. The study's objective was to identify the frequency, morphology, dimension, direction, and anatomic subtype of RS, as well as to evaluate its utility as a landmark for safe laparoscopic cholecystectomy. This is a prospective observational study conducted across multiple institutions. The study lasted six months (from July to December 2021) and included 192 patients with an age above 16 years with symptomatic gallstone who had a laparoscopic cholecystectomy. 192 patients with a mean age of 43.55 ± 11.33 years with a female-to-male ratio of 5:1 were analyzed. RS was present in 87.5% of cases, of which deep open type, deep closed type, scar type, and slit type RS were identified in 75%, 22.0%, 1.80%, and 1.2% cases, respectively. In 74.4% of cases, RS was transverse, in 24.4% of cases it was oblique, and in 1.2% of cases, it was vertical. In 97.02% of patients, the RS was at the same level, and in 2.97% of patients, it was lower than the critical view of safety. The most significant advantage of finding the RS is that the common bile duct is located below it, and the cystic duct and artery are located above it. Detection of RS is a predictor of safe laparoscopic cholecystectomy.