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Rouvière's Sulcus: An External Landmark for Safe Dissection when the Critical View Cannot Be Achieved
Shamir O Cawich1, Neil W Pearce2, Michael Kluger3
1Department of Surgery, School of Global Medicine, Nashville, Tennessee, USA.
The American Surgeon
|May 29, 2026
Summary
Rouvière's sulcus is a reliable landmark for preventing bile duct injuries during laparoscopic cholecystectomies when visible. Surgeons should use alternative methods for bile duct protection if the sulcus is not well-defined.
Area of Science:
- Hepatobiliary Surgery
- Surgical Anatomy
Background:
- Bile duct injuries are a risk during cholecystectomy.
- Rouvière's sulcus is proposed as a landmark to prevent these injuries.
- It aids dissection when the critical view of safety is compromised.
Purpose of the Study:
- To evaluate the intraoperative identification and reliability of Rouvière's sulcus in laparoscopic cholecystectomies.
- To assess its utility as a landmark for preventing bile duct injuries.
Main Methods:
- Observational study of consecutive elective laparoscopic cholecystectomies (2017-2024).
- Intraoperative identification of Rouvière's sulcus by surgeons, confirmed by an independent observer.
- Laparoscopic ultrasound used to confirm the sulcus-pedicle relationship.
Main Results:
- Rouvière's sulcus was identified in 83.2% of 356 procedures.
- A well-defined sulcus reliably correlated with the right portal triad (100% accuracy).
- Reliability decreased significantly when the sulcus was not well-defined (5% accuracy, P < 0.0001).
Conclusions:
- Rouvière's sulcus serves as a valuable landmark for safe dissection during cholecystectomy when identifiable.
- Alternative methods like indocyanine green or cholangiography are recommended when a well-defined sulcus is absent.
