Rouviere Sulcus Plane and Hepatic Hilum Plane, Which is Better as a Landmark in Laparoscopic Bile Duct Surgerys

The Second Hospital of Anhui Medical University100 enrolled

Overview

RS and the RS plane are important anatomical markers in laparoscopic cholecystectomy. However, there are many variations in the shape and orientation of the RS, and the RS plane is an imaginary plane, which can be misjudged by different surgeons. The purpose of this study is to introduce a more intuitive anatomical marker and anatomical plane, hilum plane, and discuss the application value of hilum plane in laparoscopic biliary surgery by comparing it with RS and RS plane.

Hepatic hilum plane is the hepatoduodenal serosa plane that extends from the base of the liver IVa segment down to the first segment of the gallbladder triangle. During the operation, first pulling the gallbladder to the head side, using the separating forceps to slide down horizontally from the hilum (the basement of hepatic segment Ⅳ), and along the serous of hepatoduodenal ligament, that is so called "hilum plane". It forms a "neck-shoulder" structure when the hilar plane meets the tent-like hepatobiliary triangle. the serosa of hepatobiliary triangle was dissected on the neck area and ventral side of hilar plane, and the serosa of posterior triangle of the gallbladder was also cutted on the same extension line . In this process, the type and orientation of RS, the relationship between the plane of the RS sulcus and the plane of the hilar plane were also recorded and compared with hilum plane.

Study Type

OBSERVATIONAL

Enrollment

100

Conditions

Cholelithiasis Laparoscopic Cholecystectomy

Eligibility

Sex: ALLMin age: 18 Years

Outcomes

Primary Outcomes

The type of Rouviere sulcus and the "fake RS"

The Rouviere sulcus was present if a fissure was seen in the liver parenchyma on the right side of the gallbladder and continues with the right posterior hepatic pedicle(fig ). RS were further subdivided into three classes: "open type", "fused type" or "absent type"). The "plane of RS sulcus" was also recorded If the RS was not the absent type.

Time frame: up to 30 days after surgery

The orientation of RS and The relationship between hepatic portal plane and RS plane

the RS plane is an imaginary line drawn along the sulcus and carried across to the base of segment IV and form a "security triangle". Similarly, the hilar plane can also form a triangle in posterior triangle of gallbladder. The areas of these triangles were Compared.