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