title: Rouviere's sulcus-Aspects of incorporating this valuable sign for laparoscopic cholecystectomy.
abstract: Laparoscopic cholecystectomy is one of the most common procedures performed worldwide. Despite advances in technique, injury to the common bile duct and blood vessels still occurs. Rouviere's sulcus, a naturally occurring cleft in the right lobe, anterior to Segment 1, occurs in over 80% of normal livers. It is a useful, but often ignored, anatomical landmark for beginning dissection of Calot's triangle, and also for confirming its location. Despite this, its usefulness is not widely known or appreciated by general surgeons. This article discusses the critical aspects of incorporating this useful landmark in safe laparoscopic surgery, including pitfalls, where the landmark may not be present or misleading. The useful mnemonic of "RANGERS"- Rouviere's At Neck of Gallbladder Eases Recognition of Structures, helps draw attention to the sulcus to facilitate safer laparoscopic cholecystectomy.
authors.affiliation: Medical School, Trinity College, Dublin, Ireland.
authors.forename: Stuart
authors.initials: S
authors.lastname: Lockhart
authors.affiliation: Department of General Surgery, Upper River Valley Hospital, Waterville, New Brunswick, Canada. Electronic address: gsinghranger@yahoo.co.uk.
authors.forename: Gurpreet
authors.initials: G
authors.lastname: Singh-Ranger
mesh_terms: D059925:Anatomic Landmarks; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D006801:Humans; D008099:Liver / Q000033:anatomy & histology* / Q000601:surgery
keywords: Calot's triangle; Couinaud segment IX; Rouviere's sulcus; bile duct injury; laparoscopic cholecystectomy