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