Application of “three lines and one plane” as anatomic landmarks in laparoscopic surgery for bile duct stones
Objective: To investigate the application value of using “three lines and one plane” as landmarks for extrahepatic bile ducts in laparoscopic surgery for bile duct stones. Methods: From January 2014 to December 2015, 445 cases of laparoscopic cholecystectomy and 70 cases of laparoscopic common bile duct exploration consecutively performed in the First Department of General Surgery of the Second Affiliated Hospital of Anhui Medical University. “Three lines and one plane” which refers to the upper curve of the duodenal bulb, the arc incisure curve of the hepatic pedicle of the right posterior lobe, the middle line between the common hepatic duct and the common bile duct and the plane of the hilar plate, were used as anatomical landmarks for extrahepatic bile ducts during operation in all patients. Results: No bile duct injury or surgical death occurred in any of the entire group of patients. No open surgical conversion was needed in patients undergoing laparoscopic cholecystectomy, while in those undergoing laparoscopic common bile duct exploration, one case (1.4%) was converted to open operation and 2 cases (2.9%) developed postoperative bile leakage that was cured by conservative treatment. All patients recovered uneventfully. Conclusion: Using “three lines and one plane” as guidance for dissection of the extrahepatic bile ducts can avoid bile duct and vascular injury during laparoscopic surgery for bile duct stones. So, it is recommended to be used.