Rouviere's Sulcus Anatomy and Its Overall Impact on Operative Time and Complications in Laparoscopic Cholecystectomy:...

Rouviere's sulcus (RS) is widely regarded as an important extra biliary landmark during laparoscopic cholecystectomy (LC), yet its visibility, anatomical variability, and true impact on operative safety remain debated. This study evaluates RS morphology, its incidence of absence, and its influence on operative metrics and complications in a 2-year cohort.

A longitudinal observational study was conducted at a single public hospital in the United Arab Emirates, including all elective and emergency LC cases from 2024 to 2025. Electronic medical records and operative videos were reviewed to document RS type, presence or absence, critical view (CV) dissection time, total operative time, and perioperative complications. Statistical analyses included Kruskal-Wallis, Mann-Whitney U, χ²/Fisher's exact tests, and Spearman correlation.

Among 130 LC cases, RS was identifiable in 85.4%, with 14.6% absence (95% CI: 9.56-21.70). RS morphology (open, slit, scar, and closed) showed no significant effect on CV dissection or operative time (P > .08). However, RS absence was associated with a significantly longer CV dissection time (median 20 versus 18 minutes; P = .030), while the increase in operative time did not reach significance. Demographic factors and comorbidities showed no association with RS type or visibility. Complications were infrequent (4.6%) and unrelated to RS presence. CV dissection time strongly correlated with total operative duration (ρ = 0.834).

RS was present in most patients, and its absence modestly prolonged CT dissection but did not significantly affect overall operative time or complication rates. While RS can aid orientation, it should complement rather than replace established safety strategies such as the Critical View of Safety and bailout techniques. Multicenter studies are warranted to further clarify the clinical utility of RS morphology.