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. 2023 Feb 16;27(2):201–210. doi: 10.14701/ahbps.22-064

Fig. 11.

Fig. 11

Adverse intraoperative conditions with low success rates of achieving critical view of safety (CVS). (A, B) Case of acute cholecystitis with a large stone impacted in the Hartmann’s pouch. Stone could not be dislodged. Still, the CVS could be achieved after a careful dissection. (C) Acute cholecystitis with distended gallbladder and omental adhesions over the neck and Calot’s triangle. (D) Vanishing Calot’s syndrome: Inflamed gallbladder and hepatoduodenal ligament with an obliterated Calot’s triangle. Structure that appears to be a dilated thick cystic duct is actually situated below the R4U line and passing vertically behind the duodenum; this structure (marked as B) is common bile duct. No attempt should be made to achieve the CVS in this situation.