Skip to main content
SpringerLink
Log in

The R4U Planes for the Zonal Demarcation for Safe Laparoscopic Cholecystectomy

  • Innovative Surgical Techniques Around the World
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Post-cholecystectomy bile duct injury is a serious complication. Usually, it results from structural misidentification and can be avoided by adopting the critical view of safety. The biliary, vascular, and other visceral injuries can also occur during the dissection to achieve the critical view of safety. To avoid such complication, identification of the safe area for dissection is important during laparoscopic cholecystectomy. It is imperative to start the dissection in a safe area and remain there during the procedure. Fixed anatomical landmarks can help in proper orientation to ascertain the surgical anatomy correctly during surgery. The Rouviere’s sulcus is one of such anatomical landmarks. Utilizing this sulcus, we describe a technique of zonal demarcation based on the concept of one line (the R4U line), two planes (the R4U planes), and four zones to identify a “safe area” for dissection during laparoscopic cholecystectomy to perform the procedure safely.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Gupta V, Jain G (2019) Safe laparoscopic cholecystectomy: Adoption of universal culture of safety in cholecystectomy. World J Gastrointest Surg 11:62–84

    Article  Google Scholar 

  2. Schendel J, Ball C, Dixon E et al (2020) Prevalence of anatomic landmarks for orientation during elective laparoscopic cholecystectomies. Surg Endosc 34:3508–3512

    Article  Google Scholar 

  3. Cheruiyot I, Nyaanga F, Kipkorir V, et al (2020) The prevalence of the Rouviere's sulcus: a meta-analysis with implications for laparoscopic cholecystectomy. Clin Anat. https://doi.org/10.1002/ca.23605

  4. Hugh TB, Kelly MD, Mekisic A (1997) Rouvière’s sulcus: a useful landmark in laparoscopic cholecystectomy. Br J Surg 84:1253–1254

    CAS  PubMed  Google Scholar 

  5. Society of American Gastrointestinal and Endoscopic Surgeons. The SAGES safe cholecystectomy program. Available from: URL: https://www.sages.org/safe-cholecystectomy-program/

Download references

Author information

Authors and Affiliations

  1. Department of Surgical Gastroenterology, King George’s Medical University, Lucknow, Uttar Pradesh, India

    Vishal Gupta

  2. Abdominal Transplant and Hepatobiliary Surgeon, St Luke’s Transplant Program, Milwaukee, WI, USA

    Gaurav Jain

Authors
  1. Vishal Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gaurav Jain
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vishal Gupta.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gupta, V., Jain, G. The R4U Planes for the Zonal Demarcation for Safe Laparoscopic Cholecystectomy. World J Surg 45, 1096–1101 (2021). https://doi.org/10.1007/s00268-020-05908-1

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-020-05908-1

Search

Navigation