Simple cysts are ideally approached laparoscopically. The cyst should be care­fully examined utilizing intra-operative ultrasound to confi rm a uniform thin lining with no papillary projections into the cyst lumen or hepatic parenchyma. The cyst wall typically demonstrates sharp sonographic echo demarcation secondary to the luminal fl uid interface and compressed hepatic parenchyma [ 4 ]. Simple cyst fl uid is clear and serous; however, a previous hemorrhage may produce a heterogeneous mix. In either case, the cyst should be aspirated and a generous excisional biopsy obtained for histologic evaluation. If a cystadenoma is excluded, the fenestration may proceed to wide excision of the cyst wall. Intra-operative ultrasound can be intermittently utilized to maximize wall excision without encountering major vas­cular structures. Argon beam coagulation of the remnant epithelial surface can be employed to destroy remaining biliary epithelia and recruit an infl ammatory response but is not mandatory. When operating for a presumed simple cyst, if a cystadenoma cannot be excluded or the cyst content is overtly bilious, fenestration should be abandoned for hepatic resection . If there is a potential cystadenoma, the resection should include at least a 0.5 cm margin with pathologic confi rmation. In the scenario of overtly bilious cyst fl uid, the resection is indicated to completely remove the cyst lining so as to expose biliary radicle(s) for repair.