50 F with previous vertical upper abdominal midline incision (for hepatic hydatids, done many years back)

Now had gall stones and pain and repeatedly raised alkaline phosphate values, so ERCP was done; this however revealed CBD to be clear and so we proceeded to lap chole. At operation, very dense adhesions were encountered right in front of the telescope starting from just above the umbilicus right to the top to xiphoid and extending to all of RUQ. All of these adhesions were lysed, taking about 45 minutes. Only then it was possible to  introduce the subxiphoid port, and other two working ports. The distal stomach’s adhesions with the liver were then sharply divided. The gall bladder was still hardly visible. A little further dissection under the liver revealed that the subcostal port was actually in the fundus of the supposed gall bladder. This was reintroduced properly and the liver was then freed from the abdominal wall and made a little mobile so that the gall bladder now could be flipped over.

After this the calots triangle was rather easy.

Drained.