title: The anatomy of Rouviere's sulcus as seen during laparoscopic cholecystectomy: A proposed classification.
abstract: BACKGROUND
  Although Rouviere's sulcus is being increasingly mentioned as the first landmark to be seen so as to begin dissection during laparoscopic cholecystectomy to prevent bile duct injuries, the anatomy of the sulcus has not been described in clear and simple terms.
  
  
  OBJECTIVE
  To define the detailed anatomy of Rouviere sulcus as seen during laparoscopic surgery in simple terms for the surgeons to refer to and begin their dissection from this, always staying above this sulcus in order to eliminate bile duct injury.
  
  
  METHODS
  100 recordings of laparoscopic cholecystectomy were analysed to define the anatomy of the Rouviere's sulcus.
  
  
  RESULTS
  Majority of the sulci (71) were seen as a deep sulcus and were labelled as simply the 'sulcus'. This was further seen to be of two types - open (60) or closed (11). Some of the sulci (23) were small and so narrow and shallow as to be labelled as a 'slit'. Rarely, the sulcus was found to be fused and represented by a white fusion line (6 cases), and this was simply labelled as a 'scar'.
  
  
  CONCLUSIONS
  The Rouviere's sulcus can now be defined in three simple terms - a deep sulcus, or a slit or a scar. We recommend that as a first step in laparoscopic cholecystectomy, the surgeon must look for this reference point (whether it is in the form of a scar, or a slit or a real sulcus) which will be the plane of the main bile duct, and thus avoid any dissection below this point in order to eliminate any danger to the bile duct during surgery.
authors.affiliation: Department of Surgery, Government Medical College, Patiala, Punjab, India.
authors.forename: Mohinder
authors.initials: M
authors.lastname: Singh
authors.affiliation: Department of Surgery, Government Medical College, Patiala, Punjab, India.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Prasad