A disector is passed through to isolate the cystic duct from the artery. Once the cystic artery is isolated and cleaned of its attachments the cystic duct is dissected and clearly visualized by puhing backwards the cystic artery and forward the duct in one single manouver. Upon completition of the dissection, clips are applied to the cystic artery and divided with scissors. Now the cystic duct is fisrt doubly clipped and then transected with scissors. Electrocautery or laser should not be used to avoid necrosis of tissue under the clips and possible post-operative bile leakage.
Dissection is performed through each side of the gallbladder dividing the peritoneal reflection.
The hartmann's pouch is pulled superiorly and medially to permit good field exposure while the gallbladder is being freed from the liver bed.