Critical view of safety and Rouviere's sulcus: extrahepatic biliary landmarks as a guide to safe laparoscopic cholecystectomy

Introduction
Bile duct injury is a serious complication of cholecystectomy. To fulfill the criteria for a critical view of safety requires Calot's triangle to be cleared free of fat and fibrous tissue. Rouviere's sulcus is a 2–5-cm sulcus running to the right of the liver hilum anterior to the caudate lobe.
Aim
Our aim is to study critical view of safety and Rouviere's sulcus as extrahepatic landmarks and their benefits in avoiding common bile duct injury.
Patients and methods
From January 2015 to December 2018 (35 months), in New Damietta University Hospital, 300 patients with calculous cholecystitis undergoing laparoscopic cholecystectomy were included in this study.
Results
Rouviere's sulcus was present in 293 (97.7%) patients: open type was found in 175 (58.3%) patients, whereas closed type was found in 118 (39.3%) of patients. The sulcus was not present in seven (2.3%) of patients. A critical view of safety was inspected in all patients (100%). There was conversion to open cholecystectomy in two (0.7%) patients owing to severe adhesions which cannot be dissected laparoscopically. No mortality was recorded in the follow-up period.
Conclusion
Rouviere's sulcus and critical view of safety technique are very helpful extrahepatic landmarks to avoid common bile duct injury and perform safe laparoscopic cholecystectomy.