Charles M Wojnarski ,Jason M Robke ,Scott M Wilhelm *
A 52 year-old female with a history of remote trauma requiring laparotomy presented with acute cholecystitis. She was transferred from an outside hospital following failed laparoscopic converted to attempted open cholecystectomy. The referring surgeon reported an inability to reach the gallbladder. CT scan revealed a significantly elevated, right hemidiaphragm suspicious for diaphragmatic hernia. Percutaneous cholecystostomy was performed and her acute cholecystitis resolved. Six weeks later, to definitively treat her symptomatic cholelithiasis, a unique combined approach between Thoracic and General Surgery utilizing VATS, a right thoracotomy, and an intra-operative, ultrasound guided trans-diaphragmatic cholecystectomy.