Open cholecystectomy

This figure depicts the general steps and principles to help guide safe open cholecystectomy.

Unequivocal identification of the cystic duct and cystic artery is critical in order to avoid injury to a major bile duct or arterial structure. The "critical view of safety" should ideally be achieved prior to ligation of the cystic duct or artery. The critical view of safety in laparoscopic cholecystectomy is achieved by dissecting the triangle of Calot free of all tissue except the cystic duct and cystic artery and separating the gallbladder from the lower third of the cystic plate. In open cholecystectomy, the gallbladder is ideally freed from the cystic plate entirely prior to ligation of any structure.

While most surgeons perform laparoscopic technique in "bottom up" (retrograde) fashion, many surgeons perform open cholecystectomy from the fundus downward (anterograde). In either case, no structure should be divided until the surgeon is certain of its identity.