Significance of Rouviere’s Sulcus in Hepatobiliary Surgery: A Cadaveric study

Background: Rouviere’s sulcus (RS) was first identified in 1924 by Henri Rouviere. It lies oblique to the anterior and inferior border of the liver and holds the right portal pedicle. Material and Methods: The study was conducted in the Department of Anatomy of a Medical College in Maharashtra, India, on 45 cadaveric livers. The morphological observations made were: presence/ absence RS; direction of RS (oblique/ horizontal/ vertical); sulcus type ( deep/ slit/ scar); length, width and depth; presence of right hepatic pedicle; distance of the hepatic vessels from edge of the sulcus . Results: 40 livers showed the presence of Rouviere’s Sulcus. It was absent in five specimens. Direction was horizontal in 40%, oblique in 57.5% and vertical in 2.5% .26 livers showed a deep type of sulcus, 12 showed the slit type and 2 showed scar type .29 livers showed the right hepatic pedicle entering the RS. Average length, depth, of the RS was 2.35 cm and1.07 cm respectively. The average width was 0.32cm at medial end, 0.22cm at midpoint and 0.1cm at lateral end. Present study has added the details of depth of vessels from the edge of RS, which was not recorded in earlier studies. Depth of vessels from the edge of the sulcus was average 5mm (0.5cm) for the right branch of the hepatic artery and was 12mm (1.2cm) for the right branch of portal vein. Conclusion: Rouviere’s sulcus is a reference landmark for surgeons during laparoscopic surgeries on gall bladder and during hepatic resection to avoid injuries. This study wishes to provide detailed morphological data of the Rouviere’s Sulcus to hepatobiliary surgeons including depth of hepatic vessels in the RS as an added parameter to aid them in their surgical endeavor. KEY WORDS: Rouviere’s sulcus, Anatomical Landmark, Morphology, Depth, Hepatobiliary Surgery.

The Application of Selective Hepatic Inflow Vascular Occlusion with Anterior Approach in Liver Resection: Effectiveness in Managing Major Complications and Long-Term Survival

Background. Hepatectomy is always a challenge to surgeons and requires an appropriate approach for specific tumors to achieve effective complication management. Selective hepatic pedicle clamping is more considerable strategy when comparing with total hepatic pedicle clamping in the balance between reducing blood loss and transfusion with causing the hepatic parenchyma damages (two main complications affecting liver resection result). Objectives. In this study, we aim to describe the application of selective hepatic inflow vascular occlusion (SHIVO) and anatomical anterior approach in liver resection and evaluate the results, focusing on intraoperative and postoperative complications. Methods. We enrolled 72 patients who underwent liver resection with SHIVO at Viet Duc University Hospital in 4-year period (2011-2014) and then followed up all of them until June 2020 (in 52.6 ± 33 months; range, 2-105 months) or up to the time of death. All the patients were diagnosed with primary or secondary liver cancer, and their future remnant liver volume measured on 64-slice CT scan (dm3) to body weight kg > 0.8 % (for right hepatectomy). Perioperative parameters were collected and analyzed. Results. The average operation time was 196.2 ± 62.2 minutes, and blood loss was 261.4 ± 202.9 ml; total blood transfusion proportion during and after surgery was 16.7%. Complications accounted for 44.5% of patients in which pleural effusion was the most common one (41.7%). There were no liver failure and biliary fistula after surgery. No deaths were recorded during 30 days postoperatively. Average hospital stay was 11.4 ± 3.7 days. Blood transfusions during the operation and major liver resection were the factors significantly affecting the percentage of complications after liver surgery in our study. In the last follow-up evaluation, 44 patients were dead and 28 patients were alive, in which 7 with recurrence and 21 without recurrence. The overall survival rate was 38.9%. Conclusion. SHIVO in anatomical liver resection is a safe and feasible approach to help resect precisely targeted tumors and manage several complications in liver resection.