Laparoscopic Subtotal Fenestrating Cholecystectomy in a Cirrhotic Patient

1. Introduction

2. Laparoscopic Port Placement and Identification of Gallbladder

3. Lysis of Adhesions

4. Incision of Gallbladder Visceral Peritoneum and Exposure of the Infundibulum

5. Dissection of the Hepatocystic Triangle

6. Transition to Subtotal Cholecystectomy When Triangle of Safety Unable to be Visualized

7. Removal of Gallbladder Content

8. Transection of Gallbladder Wall

9. Removal of Internal Biliary Drainage Catheters, Inspection of Gallbladder, and Hemostasis

10. Identification and Ligation of Cystic Duct Orifice

11. Resection of Anterior Gallbladder Wall

12. Hemostasis of Remnant Posterior Gallbladder Wall, and Inspection of Ligated Cystic Duct

13. Removal of Specimen and Final Inspection

14. Drain Placement

15. Laparoscopic Port Removal and Closure

16. Post-op Remarks