This is a 49-year-old woman with a history of polycystic kidney and liver disease presenting with progressive constant abdominal pain associated with occasional vomiting, due to marked hepatomegaly. She has preserved kidney function. She was taken to the operating room for a laparoscopic right hepatectomy. It was critical to maintain the axis of transection because of the amount of anatomic distortion. Our approach was to identify the porta hepatis and to transect the liver along the inferior vena cava to obtain an anatomic transection. Contrary to a typical laparoscopic hepatectomy where the preferred instrument for transection is a LigaSure, this case necessitated the use of the stapler. This is because there was no visible parenchyma and the vasculature and bile ducts were pushed into the cyst walls. In order to maintain the safest transection, we were very methodical in our approach. We first identified cysts in-line with our transection and decompressed them. Then we used the Endo-GIA stapler to transect the liver. To ensure hemostasis at the end of the case, we decreased insufflation the abdomen to 5cm H2O, ensuring no venous bleeding at the lower pressures. Post-operatively, the patient was able to resume daily activities without limitations. Her abdominal pain and vomiting had resolved. Her postoperative CT scan showed that we successfully decreased the size burden of her liver. Four years postoperatively, the patient reported very modest growth of her abdomen and minimal abdominal pain.