Understanding Rouviere's sulcus is crucial for safe cholecystectomy and hepatectomy. With increasing use of the Glissonean pedicle approach in right-sided hepatectomy, precise knowledge of its anatomy is essential. This study investigates the presence and contents of Rouviere's sulcus and proposes a preoperative assessment method to enhance surgical safety. Patients who underwent laparoscopic or robotic right-sided hepatectomy were analyzed, focusing on cases where identification and dissection of Rouviere's sulcus were performed. The sulcus was classified as open or closed, and the Glissonean pedicle contents were examined. Findings were compared with 3-dimensional reconstruction imaging simulations. Among 83 patients, 74.7% (62) had an open-type sulcus, while 25.3% (21) had the closed type. In open-type cases, 61.3% (38) contained the right posterior Glissonean pedicle, while 30.7% (19) contained the segment 6 pedicle. When the right posterior Glissonean pedicle did not form a common trunk with segments 6 and 7, the segment 6 pedicle was within the sulcus. Notably, 8.1% (5) of patients had the right main Glissonean pedicle in the sulcus, requiring careful surgical consideration. A precise understanding of the anatomy of the Rouviere's sulcus is crucial for safe right-sided hepatectomy. This study highlights its anatomical variability, particularly the presence of different Glissonean pedicles, including the right posterior, segment 6, and, in rare cases, the right main Glissonean pedicle. These findings emphasize the necessity of individualized preoperative imaging and careful consideration of anatomical variations to minimize complications during right-sided hepatectomy.
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