Role of the Right Portal Pedicle and Rouviere’s Sulcus as an Anatomic Landmark in Laparoscopic Cholecystectomy

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Brief Title

Role of the Right Portal Pedicle and Rouviere's Sulcus as an Anatomic Landmark in Laparoscopic Cholecystectomy

Official Title

Role of the Right Portal Pedicle and Rouviere's Sulcus as an Anatomic Landmark in Laparoscopic Cholecystectomy in Chinese Population

Brief Summary

      Objective:To explore the role of the right portal pedicle and Rouviere's sulcus as an
      anatomic landmark in laparoscopic cholecystectomy.

      Methods:The investigators are going to select 60 patients intending to perform Laparoscopic
      cholecystectomy from April 2014 to April 2015.Check out the presence of the right portal
      pedicle and Rouviere's sulcus during the surgery and divide into the experimental group and
      the control group.Experimental group operated in Laparoscopic cholecystectomy with the guide
      of Rouviere's sulcus while the Control group operated with the traditional way.

      Research hypothesis:Compare the differences between the Experimental group and the Control
      group in bile duct injury rate,complication rate,blood loss,operative time ,conversion rate
      and hospital stay.It is supposed that the results of Experimental group are superior to the
      control group,difference is statistically significant(P<0.05). So the investigators can draw
      the conclusion that the anatomy method with the guide of right portal pedicle and Rouviere's
      sulcus is useful in laparoscopic cholecystectomy.
    

Detailed Description

      Surgical procedures(Experimental group ):Placing the grasping forceps on the neck of the
      gallbladder, then retracted upwards and towards the left, so that the posterior aspect of the
      hepatobiliary triangle is exposed. the sulcus is seen running to the right of the hilum . In
      some patients, the lips of the sulcus are partially fused, with only a small cleft visible
      laterally. The sulcus indicates reliably the plane of the common bile duct; dissection may be
      started safely by division of the peritoneum immediately ventral to the sulcus and continued
      in a triangle bounded by the liver surface, the neck of the gallbladder and the plane of the
      sulcus. Even if the bile duct is tented upwards by the traction that has been exerted on the
      gallbladder, dissection will be safely ventral to the plane of the duct. Posterior branches
      of the cystic artery, may lie in the area of dissection and must be identified with care.Once
      a plane has been opened posteriorly, attention may be turned to the anterior dissection,
      using the posterior landmarks as a guide. The anterior and posterior dissections can then be
      made to meet, thus opening the hepatobiliary triangle completely.

      Surgical procedures(Control group ):A small periumbilical incision is made, with the location
      and orientation depending on the patient's body habitus and cosmetic considerations.The
      laparoscope is used to explore the abdomen for adhesions and potential injuries that may have
      occurred during port placement,ratcheted grasper is inserted through the lateral 5-mm port to
      retract the gallbladder fundus in cephalad fashion. An atraumatic grasper is inserted through
      the middle 5-mm port to retract the gallbladder infundibulum laterally, exposing the
      anteromedial aspect of the triangle of Calot. A hook cautery is used to carefully incise the
      peritoneum overlying the triangle of Calot, continuing along the medial aspect of the
      proximal gallbladder. As the infundibulum is retracted superomedially, peritoneum overlying
      the posterolateral aspect of the triangle of Calot is similarly incised using hook cautery.
      All remaining connective tissue is dissected out of the triangle of Calot using blunt
      dissection and hook cautery as needed to fully mobilize the gallbladder infundibulum.
    


Study Type

Interventional


Primary Outcome

complication rate

Secondary Outcome

 conversion rate

Condition

Gallstones

Intervention

Rouviere's sulcus

Study Arms / Comparison Groups

 Rouviere's Sulcus
Description:  Rouviere's sulcus is a 2 to 5 cm sulcus running to the right of the liver hilum anterior to the caudate process and usually containing the right portal triad or its branches.Dissection may be started safely by division of the peritoneum immediately ventral to the sulcus and continued in a triangle bounded by the liver surface, the neck of the gallbladder and the plane of the sulcus.

Publications

* Includes publications given by the data provider as well as publications identified by National Clinical Trials Identifier (NCT ID) in Medline.

Recruitment Information


Recruitment Status

Procedure

Estimated Enrollment

60

Start Date

April 2014

Completion Date

April 2015

Primary Completion Date

April 2015

Eligibility Criteria

        Inclusion Criteria:

          -  Symptomatic gallstones

          -  Gallstones>3cm in diameter

          -  Fulfilled gallstones

          -  Acute or chronic cholecystitis

          -  Acalculous cholecystitis

          -  Gallbladder polyps >10mm in diameter

          -  Symptomatic gallbladder polyps

          -  Gallbladder stones associated with polyps

          -  Porcelain gallbladder

          -  Gallstone pancreatitis

        Exclusion Criteria:

          -  Suspicion of gallbladder cancer

          -  General condition is poor,inability to tolerate gallbladder cancer

          -  Important organ dysfunction

          -  Severe abdominal cavity adhesion

          -  Bleeding disorders,blood coagulation dysfunction

          -  Acute cholangitis with serious complications(gallbladder empyema,gangrene,perforation)

          -  Acute cholangitis

          -  Pregnancy(first or third trimester)

          -  Abdominal dysfunction or peritonitis
      

Gender

All

Ages

20 Years - 75 Years

Accepts Healthy Volunteers

No

Contacts

Fan yi fang, Prof., +86-02062783391, [email protected]

Location Countries

China

Location Countries

China

Administrative Informations


NCT ID

NCT02133027

Organization ID

Fanyingfang3


Responsible Party

Sponsor

Study Sponsor

Zhujiang Hospital


Study Sponsor

Fan yi fang, Prof., Principal Investigator, Department of Hepatobiliary Surgery(I),Zhujiang Hospital


Verification Date

May 2014