Application of “three lines and one plane” as anatomic landmarks in laparoscopic surgery for bile duct stones

Abstract

To investigate the clinical application ofthe “three lines and one plane” concept as the anatomic landmarks during laparoscopic common bile duct exploration (LCBDE).From January 2014 to February 2017, 148 cases of LCBDE performed in the General Surgery Department of the 2nd affiliated Hospital of Anhui Medical University were recruited, and analyzed in this study. “Three lines and one plane” was applied as anatomical landmarks during LCBDE, and the perioperative clinical outcomes were analyzed.No serious operational complications occurred in all the patients in this study. Two cases (1.4%) was converted to open operation. Two other cases (1.4%) suffered post-operative bile leakage and were cured by conservative treatment. All patients recovered uneventfully.Anatomical landmarks of “three lines and one plane” is benefit in helping surgeons to build a three-dimensional (3D) anatomical construction, and avoiding the operative injury of the bile duct, and vessels.

The hilar plane compared with the Rouviere's sulcus plane during laparoscopic cholecystectomy.

“…Many methods and strategies have been adopted to reduce the incidence of BDI [ 4 , 7 – 9 , 11 , 16 – 21 ]. Intraoperative ultrasound, fluorescence cholangiography with indocyanine green (ICG), and intraoperative cholangiography (IOC) can help to identify the common bile duct and reduce the risk of BDI and all belong to the surgeon’s armamentarium [ 17 – 21 ].…”

“…In this study, the most frequently used classification method was used [ 15 ], which included open type, fused type, and absent type. RS was present if a fissure or hole was seen in the liver parenchyma on the right side of the gallbladder, and its tip was pointing to the hilum hepatis or extending from the arc incisure of the right posterior hepatic pedicle [ 11 ], whether or not the main or branches of the right posterior hepatic pedicle was visible in the fissure. The key step was to expose the posterior triangle of the gallbladder by retracting the ampulla of gallbladder to the left, or exposing the right and posterior of the hepatoduodenal ligament.…”

“…In this department, an extended plane of the hilar plate (hilar plane) was safely used as a landmark and a set of standardized procedures was formulated with reference to the hilar plane during LC and laparoscopic common bile duct exploration (LCBDE) in more than 6000 cases since 2014 [ 11 ], including some complex conditions, without bile duct injury.…”

Surgical strategies for challenging common bile duct stones in the endoscopic era: A comprehensive review of current evidence

“…The “three lines and one plane” concept, comprising of the duodenal edge, inferior border of right posterior hepatic pedicle or Rouviere’s sulcus, midline of CHD/CBD, and the plane of hilar plate, can help during dissection. In cases of severe inflammation or adhesion, inferior mobilization of duodenum enhances visibility of CBD for a clearer view[ 60 ].…”

The supraduodenal pedicle can be a useful landmark of the common bile duct in laparoscopic cholecystectomy.

“…As the CBD constantly passes through the first part of the duodenum, it is possible to find the CBD on the upper edge of the first part of the duodenum where it is far away from the severe edema and adhesion in Calot's triangle [3]. Some constant vessels in this region were observed, which aided in recognition of the CBD during laparoscopy.…”