Abstract
Background
We sought to determine the prevalence of common anatomic landmarks around the gallbladder that may be useful in orienting surgeons during laparoscopic cholecystectomy.
Methods
The subhepatic anatomy of 128 patients undergoing elective cholecystectomy was recorded. We searched and recorded the presence of five anatomic landmarks: the bile duct (B), the Sulcus of Rouviere (S), the left hepatic artery (A), the umbilical fissure (F), and the duodenum (E). These are the previously described B-SAFE landmarks.
Results
We found that the duodenum and umbilical fissure were present reliably in almost all patients. The position of the left hepatic artery could be reliably determined by its pulsation in 84% of patients. A portion of the bile duct could be seen in 77% and the Sulcus of Rouviere was present in 80%. Furthermore, the hepatobiliary triangle was always found superior or at the same level as the Sulcus of Rouviere.
Conclusions
We found that these five anatomic landmarks were reliably present. This suggest that using the B-SAFE landmarks may allow a surgeon to more easily orient before and during laparoscopic cholecystectomy and prevent bile duct injuries.
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Dr. J Schendel has no conflicts of interest or financial ties to disclose. Dr. C Ball has no conflicts of interest or financial ties to disclose. Dr. E Dixon has no conflicts of interest or financial ties to disclose, Dr. F Sutherland has no conflicts of interest or financial ties to disclose.
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Schendel, J., Ball, C., Dixon, E. et al. Prevalence of anatomic landmarks for orientation during elective laparoscopic cholecystectomies. Surg Endosc 34, 3508–3512 (2020). https://doi.org/10.1007/s00464-019-07131-z
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DOI: https://doi.org/10.1007/s00464-019-07131-z