Scenario Analysis: This scenario presents a professional challenge due to the inherent complexities of advanced trauma systems surgery, particularly in a resource-constrained Sub-Saharan African setting. The critical need for timely and effective intervention, coupled with potential limitations in specialized equipment, personnel, and established protocols, demands a high degree of clinical judgment, ethical consideration, and adherence to advanced practice standards. The surgeon must balance immediate patient needs with the long-term sustainability and ethical implications of their actions within the existing trauma system framework. Correct Approach Analysis: The best professional practice involves a comprehensive, multidisciplinary approach that prioritizes patient safety and system integrity. This includes meticulous pre-operative assessment, clear communication with the surgical team and other healthcare professionals, and adherence to established advanced practice guidelines for trauma surgery. Crucially, it necessitates a thorough understanding of the patient’s condition, the available resources, and the potential risks and benefits of any proposed intervention. This approach ensures that decisions are evidence-based, ethically sound, and aligned with the principles of advanced trauma care, promoting optimal patient outcomes while respecting the limitations and capabilities of the local trauma system. Incorrect Approaches Analysis: One incorrect approach involves proceeding with a highly complex, experimental surgical technique without adequate consultation or consideration of local resource limitations. This fails to uphold the advanced practice standard of practicing within one’s scope and the capabilities of the available system. It risks patient harm due to potential complications that cannot be managed effectively in the local setting and disregards the ethical imperative to avoid unnecessary risk. Another incorrect approach is to delay definitive surgical management significantly due to minor concerns about equipment availability, without exploring all available alternatives or seeking immediate collaborative solutions. While caution is necessary, prolonged delay in critical trauma cases can lead to irreversible damage and poorer outcomes, violating the advanced practice standard of timely intervention in life-threatening situations. This approach may also indicate a failure to adequately assess and mitigate risks associated with resource constraints. A third incorrect approach is to delegate critical aspects of the advanced trauma surgery to less experienced personnel without direct, expert supervision, solely to expedite the procedure. This contravenes the advanced practice standard of ensuring appropriate skill and oversight for complex surgical interventions, potentially compromising patient safety and the integrity of the trauma system. Professional Reasoning: Professionals facing such scenarios should employ a structured decision-making process. This begins with a rapid, accurate assessment of the patient’s physiological status and the nature of their injuries. Concurrently, an evaluation of available resources, including personnel, equipment, and established protocols, is essential. The next step involves consulting with the multidisciplinary team to discuss potential treatment options, weighing the risks and benefits of each in the context of the patient’s condition and the system’s capabilities. Ethical considerations, such as patient autonomy, beneficence, non-maleficence, and justice, must be integrated throughout this process. Finally, the chosen course of action should be clearly documented, and ongoing reassessment of the patient’s response and system performance is paramount.

Scenario Analysis: This scenario is professionally challenging because it involves a critical decision with immediate life-or-death implications, requiring the surgeon to balance immediate patient needs with the long-term implications of resource allocation and ethical considerations within a resource-constrained environment. The surgeon must navigate potential conflicts between established protocols and the unique circumstances of a mass casualty event, demanding rapid, informed, and ethically sound judgment. Correct Approach Analysis: The best professional approach involves prioritizing immediate life-saving interventions for the most severely injured patients who have a reasonable chance of survival with available resources, while simultaneously initiating a structured triage process to assess and manage other casualties. This aligns with the core principles of emergency medicine and trauma care, emphasizing the greatest good for the greatest number. In a mass casualty event, established triage protocols, such as those informed by the Advanced Trauma Life Support (ATLS) principles, are designed to guide these difficult decisions by categorizing patients based on the severity of their injuries and their likelihood of survival with prompt medical intervention. This systematic approach ensures that limited resources are directed where they can have the most impact, maximizing the potential for positive outcomes. Incorrect Approaches Analysis: One incorrect approach would be to focus solely on the order in which patients arrived, regardless of their injury severity or prognosis. This fails to acknowledge the ethical imperative to save the most lives possible and can lead to valuable resources being expended on patients with little chance of survival, thereby neglecting those who could be saved. Another incorrect approach would be to defer all decision-making to a higher authority without taking any immediate action. While consultation is important, in a mass casualty event, immediate life-saving measures may be required before a superior can be reached or provide guidance. This inaction can result in preventable deaths. A third incorrect approach would be to attempt to provide comprehensive care to every patient simultaneously, regardless of the severity of their injuries or the availability of resources. This is unsustainable in a mass casualty scenario and will inevitably lead to a dilution of care, potentially compromising the outcomes for all patients and overwhelming the available medical personnel and equipment. Professional Reasoning: Professionals facing such a scenario should employ a structured decision-making process that begins with a rapid assessment of the overall situation and the number of casualties. This should be followed by the immediate implementation of a recognized triage system to categorize patients based on the severity of their injuries and their potential for survival. Concurrently, they must assess available resources and communicate needs to higher authorities or supporting agencies. Ethical considerations, such as the principle of beneficence (acting in the best interest of the patient) and justice (fair distribution of resources), must guide every decision. Continuous reassessment of patient conditions and resource availability is crucial throughout the event.

Scenario Analysis: This scenario presents a professional challenge due to the critical nature of surgical outcomes and the potential for adverse events. The need for timely and accurate documentation, especially in a resource-constrained environment like Sub-Saharan Africa, is paramount. Balancing the immediate demands of patient care with the imperative of thorough record-keeping requires careful judgment and adherence to established protocols. The pressure to manage multiple critical cases simultaneously can lead to shortcuts that compromise patient safety and regulatory compliance. Correct Approach Analysis: The best professional practice involves meticulously documenting all surgical interventions, including the intraoperative findings and any deviations from the planned procedure, immediately after the surgery is completed, or as soon as the surgeon is able to do so without compromising patient care. This approach ensures that the medical record accurately reflects the patient’s condition and the care provided, which is essential for continuity of care, medico-legal purposes, and quality improvement initiatives. Adherence to established surgical documentation standards, often guided by national medical council guidelines or hospital policies, is a fundamental ethical and regulatory requirement. This ensures transparency, accountability, and the ability to review and learn from surgical events. Incorrect Approaches Analysis: Failing to document intraoperative findings or deviations from the planned procedure until days later, or relying solely on verbal handover without written confirmation, represents a significant failure. This delays the creation of an accurate and complete medical record, increasing the risk of information loss, misinterpretation, or omission. It directly contravenes the principles of good medical practice and can lead to inadequate post-operative management, compromised patient safety, and potential legal ramifications. Such an approach undermines the integrity of the patient’s medical history and hinders any subsequent review or audit processes. Documenting only the planned procedure and omitting any intraoperative findings or complications is also professionally unacceptable. The surgical record must reflect what actually happened during the operation, not just what was intended. This omission can mask critical events, prevent appropriate follow-up care, and create a misleading record that does not serve the patient’s best interests or meet regulatory expectations for comprehensive medical documentation. Relying on junior staff to document complex intraoperative findings without direct surgeon review or sign-off is another failure. While delegation can be appropriate, the ultimate responsibility for the accuracy and completeness of the surgical record rests with the operating surgeon. This approach risks the introduction of errors or omissions due to the junior staff’s potential lack of experience or understanding of the nuances of the procedure, thereby compromising the integrity of the record and potentially patient care. Professional Reasoning: Professionals should employ a structured approach to documentation, prioritizing accuracy and timeliness. This involves understanding the regulatory and ethical imperatives of maintaining a complete and contemporaneous medical record. When faced with high-pressure situations, it is crucial to adhere to established protocols for documentation, even if it requires a brief pause or a structured handover process. Professionals should develop a habit of completing essential documentation immediately post-procedure or as soon as feasible, recognizing it as an integral part of patient care, not an afterthought. In situations where immediate documentation is impossible, a clear, documented handover process to a responsible colleague, followed by prompt personal completion of the record, is essential.

This scenario is professionally challenging due to the critical nature of trauma resuscitation, the potential for rapid deterioration, and the need for immediate, evidence-based interventions under extreme pressure. The requirement to balance immediate life-saving measures with the need for accurate documentation and communication in a resource-limited setting adds significant complexity. Careful judgment is required to prioritize actions, ensure patient safety, and maintain professional standards. The best approach involves immediate initiation of the Advanced Trauma Life Support (ATLS) primary survey and resuscitation, concurrently with delegating specific tasks to the available team members. This ensures that critical interventions like airway management, breathing support, and circulation stabilization are addressed without delay, adhering to established trauma protocols. The ATLS framework provides a systematic, evidence-based approach to trauma care, prioritizing life-threatening injuries. Simultaneously, assigning roles to the nursing staff for vital sign monitoring, intravenous access, and preparing for further investigations ensures efficient use of resources and a coordinated team effort, aligning with principles of effective team-based care in emergency medicine. This proactive delegation, guided by the ATLS principles, maximizes the chances of a positive patient outcome. An incorrect approach would be to delay definitive airway management until a formal handover is completed. This failure to act decisively in the face of a compromised airway directly contravenes the immediate life-saving priorities of trauma resuscitation and could lead to irreversible hypoxic brain injury or death. It demonstrates a lack of understanding of the urgency required in critical care and a disregard for established protocols that emphasize immediate airway assessment and intervention. Another incorrect approach is to focus solely on obtaining a detailed patient history from the ambulance crew before initiating any interventions. While history is important, in a critically injured patient, the primary survey and resuscitation take precedence. Delaying essential interventions based on a non-critical piece of information, such as a full history, can be detrimental. This approach prioritizes information gathering over immediate patient needs, which is a significant ethical and professional failing in emergency trauma care. Finally, an incorrect approach would be to attempt to manage the patient alone without seeking assistance or delegating tasks. This overestimation of personal capacity in a high-acuity situation is dangerous. It leads to delays in critical interventions, potential for errors due to overwhelming workload, and a failure to utilize the skills of other available healthcare professionals. This demonstrates poor situational awareness and a lack of understanding of effective team dynamics in managing critically ill patients. Professionals should employ a structured decision-making process that begins with rapid assessment of the patient’s physiological status, followed by immediate application of established resuscitation protocols (like ATLS). Concurrent with these actions, effective communication and delegation to the team are crucial. This involves clearly assigning roles based on available skills and the patient’s immediate needs, ensuring that all critical aspects of resuscitation are addressed efficiently and safely. Continuous reassessment of the patient’s condition and adaptation of the treatment plan are also vital components of this process.

Scenario Analysis: This scenario presents a significant professional challenge due to the immediate and life-threatening nature of the complication, coupled with the need for rapid, informed decision-making under pressure. The surgeon must balance the patient’s critical condition with the ethical imperative to obtain informed consent, even in emergent situations, and adhere to established protocols for managing surgical emergencies. The lack of immediate family contact adds a layer of complexity, requiring the surgeon to navigate consent procedures in a challenging context. Correct Approach Analysis: The best professional practice involves proceeding with the necessary life-saving intervention while simultaneously initiating the process for obtaining consent as soon as practically possible. This approach prioritizes the patient’s immediate survival, which is the paramount ethical duty in an emergency. Simultaneously, the surgeon must document the emergent nature of the situation and the rationale for proceeding without prior explicit consent, and then diligently seek consent from the next of kin or appropriate surrogate as soon as they are available. This aligns with the ethical principle of beneficence (acting in the patient’s best interest) and the legal framework that allows for implied consent in life-threatening emergencies when explicit consent cannot be obtained. The commitment to obtaining retrospective consent demonstrates respect for patient autonomy and good governance. Incorrect Approaches Analysis: Proceeding with the intervention without any attempt to contact family or document the emergent circumstances is ethically and legally problematic. While the patient’s life is at risk, a complete disregard for the consent process, even in an emergency, can lead to legal challenges and undermine patient autonomy. The failure to document the emergent nature of the situation leaves the medical team vulnerable. Delaying the life-saving intervention until explicit consent is obtained from a family member, even if attempts are made to contact them, is ethically unacceptable when the patient’s life is in immediate danger. This prioritizes the procedural aspect of consent over the patient’s fundamental right to life and well-being, violating the principle of beneficence. Performing a more extensive or different procedure than what is strictly necessary to manage the immediate complication, without further consultation or consent, constitutes a breach of professional duty and patient autonomy. It suggests a lack of focused decision-making and potentially exposes the patient to unnecessary risks. Professional Reasoning: In emergent surgical situations, the professional decision-making process must follow a hierarchy of priorities. First and foremost is the preservation of life and limb. This is followed by the ethical and legal requirement to obtain informed consent. When these two are in conflict due to the emergent nature of the situation, the immediate life-saving intervention takes precedence, but the process of obtaining consent must be initiated concurrently or as soon as feasible. Documentation of the emergent circumstances and the rationale for any deviation from standard consent procedures is crucial. Professionals should always strive to involve the patient or their surrogates in decision-making to the greatest extent possible, even under duress.

The analysis reveals a common challenge in competency assessment systems: balancing the need for rigorous evaluation with the practical realities of professional development and system sustainability. This scenario is professionally challenging because it requires a nuanced understanding of the assessment blueprint, its scoring mechanisms, and the established retake policies, all within the context of ensuring competent trauma surgeons practice in Sub-Saharan Africa. The pressure to maintain high standards must be weighed against the potential for overly punitive policies that could hinder the development of much-needed surgical expertise in the region. Careful judgment is required to interpret and apply the assessment framework fairly and effectively. The best professional approach involves a thorough review of the candidate’s performance against the established blueprint weighting and scoring criteria, coupled with a clear understanding of the retake policy as it is officially documented and communicated. This approach prioritizes adherence to the established framework, ensuring consistency and fairness in the assessment process. The regulatory and ethical justification lies in upholding the integrity of the competency assessment system. By following the documented blueprint weighting and scoring, and applying the retake policy as intended, the assessment body demonstrates transparency and accountability. This ensures that all candidates are evaluated on the same objective criteria, and that retake opportunities are provided in a structured and predictable manner, thereby supporting the development of competent surgeons without compromising standards. An approach that focuses solely on the candidate’s perceived effort or the urgency of their need for certification, without strict adherence to the blueprint weighting and scoring, is professionally unacceptable. This failure stems from a disregard for the objective criteria that form the foundation of the competency assessment. It introduces subjectivity and bias, undermining the validity of the assessment and potentially leading to the certification of individuals who may not have met the required standards. Ethically, it breaches the principle of fairness and equity. Another professionally unacceptable approach is to deviate from the established retake policy based on anecdotal evidence or personal discretion, such as allowing an immediate retake without the required waiting period or additional preparatory steps. This undermines the structured nature of the assessment and retake process, which is designed to allow candidates time for remediation and further learning. Such deviation can create an uneven playing field and erode confidence in the assessment system. It fails to uphold the established guidelines, which are in place to ensure a standardized and fair process for all. Finally, an approach that prioritizes expediency over thoroughness, such as making a provisional certification based on a partial understanding of the blueprint weighting or a misinterpretation of the scoring, is also professionally unsound. This risks misrepresenting a candidate’s actual competency and could have serious implications for patient safety. It demonstrates a lack of diligence in applying the assessment framework and a failure to uphold the professional responsibility to ensure that only demonstrably competent individuals are certified. The professional decision-making process for similar situations should involve: 1) Consulting the official assessment blueprint and scoring guidelines to understand the weighting and criteria. 2) Reviewing the documented retake policy thoroughly. 3) Objectively evaluating the candidate’s performance against these established standards. 4) Applying the retake policy consistently and fairly. 5) Documenting all decisions and the rationale behind them. 6) Seeking clarification from assessment authorities if any aspect of the blueprint, scoring, or policy is unclear.

Scenario Analysis: This scenario is professionally challenging because it requires a surgeon to balance the immediate demands of patient care with the long-term imperative of professional development and competency maintenance. The pressure to operate, coupled with limited personal time and resources, can lead to shortcuts in preparation. However, failing to adequately prepare for a complex procedure, especially in a resource-constrained environment like Sub-Saharan Africa where complications can have severe consequences, poses significant risks to patient safety and undermines professional standards. Careful judgment is required to prioritize preparation without compromising essential surgical services. Correct Approach Analysis: The best professional practice involves a proactive and structured approach to candidate preparation, recognizing that competency assessment is an ongoing process, not a one-time event. This includes dedicating specific, scheduled time for reviewing relevant literature, practicing surgical techniques (e.g., using simulation models if available), and engaging with experienced colleagues for mentorship and case discussions. This approach aligns with the ethical obligation to provide competent care and the professional responsibility to maintain and enhance surgical skills. Regulatory frameworks for medical professionals universally emphasize the importance of continuous professional development and ensuring competence before undertaking procedures, particularly those that are complex or outside of routine practice. This structured preparation ensures that the surgeon is not only familiar with the theoretical aspects but also has honed the practical skills necessary for successful outcomes, thereby upholding patient safety and professional integrity. Incorrect Approaches Analysis: One incorrect approach involves relying solely on prior experience and assuming that recent operative volume is sufficient preparation. This fails to acknowledge that surgical techniques evolve, and specific case complexities require focused review. It neglects the ethical duty to be thoroughly prepared for each individual patient’s needs and can lead to suboptimal outcomes due to overlooking new evidence-based practices or specific anatomical variations. Another unacceptable approach is to defer preparation until immediately before the assessment, cramming information and practice in a short, high-stress period. This method is often ineffective for deep learning and skill consolidation. It increases the likelihood of errors due to fatigue and inadequate retention, violating the principle of providing the highest standard of care and potentially contravening guidelines that advocate for systematic and timely preparation for assessments. A further flawed strategy is to prioritize other clinical duties over dedicated preparation time, believing that the assessment can be managed with minimal extra effort. This demonstrates a lack of commitment to professional development and patient safety. It suggests a misunderstanding of the rigorous nature of competency assessments and the ethical imperative to be fully prepared, potentially leading to a failure in the assessment and, more importantly, a risk to patients if similar underpreparedness were to occur in clinical practice. Professional Reasoning: Professionals should adopt a systematic approach to competency assessment preparation. This involves understanding the assessment’s scope and requirements, creating a realistic study and practice schedule well in advance, and seeking feedback from peers and mentors. The decision-making process should prioritize patient safety and ethical obligations, recognizing that adequate preparation is a cornerstone of responsible surgical practice. This proactive stance ensures that the surgeon is not only prepared for the assessment but also continuously improving their ability to provide excellent patient care.

This scenario is professionally challenging because it requires balancing the immediate need for surgical intervention with the imperative of patient safety and resource optimization in a resource-constrained environment. The surgeon must make critical decisions under pressure, considering potential complications and the availability of necessary support. Careful judgment is required to ensure that the operative plan is not only technically sound but also ethically responsible and compliant with established best practices for trauma care. The best approach involves a comprehensive, structured operative planning process that explicitly identifies and mitigates potential risks. This includes a thorough pre-operative assessment, detailed discussion with the surgical team, anticipation of likely complications, and the establishment of contingency plans. This structured approach aligns with the ethical principles of beneficence (acting in the patient’s best interest) and non-maleficence (avoiding harm) by proactively addressing potential adverse outcomes. It also reflects a commitment to professional accountability and the highest standards of surgical care, even in challenging circumstances. An approach that proceeds with surgery without a detailed risk assessment and mitigation strategy is professionally unacceptable. This failure to plan proactively exposes the patient to unnecessary risks and violates the principle of non-maleficence. It also demonstrates a lack of due diligence and professional responsibility, potentially leading to suboptimal outcomes and increased morbidity or mortality. Another unacceptable approach is to delay definitive surgical management solely due to minor resource limitations without a clear, evidence-based rationale for the delay and without exploring all available alternatives for risk mitigation. While resource constraints are a reality, a complete abandonment of necessary surgical intervention without exploring all avenues for safe execution or appropriate referral is ethically problematic and potentially harmful to the patient. Finally, proceeding with surgery based on assumptions about the patient’s condition or the availability of resources, without explicit verification and planning, is a significant professional failing. This reliance on assumption rather than structured assessment can lead to critical oversights, unpreparedness for complications, and ultimately, patient harm. It undermines the systematic approach required for safe surgical practice. Professionals should employ a decision-making framework that prioritizes a systematic pre-operative assessment, including a detailed review of the patient’s condition, imaging, and relevant history. This should be followed by a structured team briefing where potential operative findings, complications, and management strategies are discussed. Risk mitigation should be an integral part of this planning, with specific attention paid to resource availability and the development of contingency plans. Continuous evaluation of the plan and open communication within the team are essential throughout the peri-operative period.

The scenario presents a significant professional challenge due to the inherent tension between immediate patient need and the established protocols for managing potentially infectious diseases in a resource-limited setting. The surgeon must balance the urgency of life-saving surgery with the responsibility to protect themselves, other patients, and healthcare staff from potential transmission. This requires a nuanced application of clinical judgment, adherence to infection control principles, and effective communication. The best approach involves a systematic and collaborative process that prioritizes patient safety while mitigating risks. This begins with a rapid but thorough assessment of the patient’s condition and the potential for infectious disease, followed by immediate implementation of appropriate personal protective equipment (PPE) and isolation precautions. Crucially, this approach mandates prompt consultation with infectious disease specialists or public health authorities to guide further management and testing. This aligns with the fundamental ethical principles of beneficence (acting in the patient’s best interest) and non-maleficence (avoiding harm), as well as the professional duty to maintain a safe healthcare environment. Adherence to established infection control guidelines, even in challenging circumstances, is paramount. An incorrect approach would be to proceed with surgery without adequate PPE or isolation measures, solely based on the urgency of the trauma. This disregards the potential for transmission of an unknown pathogen, thereby violating the principle of non-maleficence by exposing others to unnecessary risk. It also fails to uphold the professional responsibility to follow established infection control protocols, which are designed to prevent healthcare-associated infections. Another incorrect approach would be to delay essential surgical intervention indefinitely while awaiting definitive diagnostic results for a potential infectious agent. While caution is necessary, prolonged delay in life-saving surgery can lead to irreversible harm or death, failing the principle of beneficence. This approach prioritizes a hypothetical future risk over a present, life-threatening condition without a balanced risk-benefit assessment. Finally, an incorrect approach would be to attempt to manage the situation unilaterally without seeking expert consultation. This demonstrates a failure to recognize the limits of one’s own expertise in complex infectious disease scenarios and neglects the collaborative nature of modern healthcare, which is essential for optimal patient outcomes and public health protection. It bypasses established pathways for risk assessment and management. Professionals should employ a decision-making framework that involves: 1) Rapid situational assessment, including potential risks. 2) Immediate implementation of universal precautions and appropriate PPE. 3) Urgent consultation with relevant specialists (e.g., infectious disease, public health). 4) Collaborative development of a management plan that balances immediate clinical needs with infection control and diagnostic strategies. 5) Continuous reassessment and adaptation of the plan based on new information.

Scenario Analysis: This scenario is professionally challenging because it involves a critical surgical intervention in a resource-limited setting where immediate access to advanced diagnostic imaging and specialized surgical equipment is compromised. The surgeon must balance the immediate need for life-saving intervention with the potential for iatrogenic injury due to incomplete anatomical visualization. Careful judgment is required to proceed safely and effectively, adhering to ethical principles of beneficence and non-maleficence, while also considering the practical limitations of the environment. Correct Approach Analysis: The best professional practice involves a meticulous, step-by-step approach to dissection, prioritizing identification of key anatomical landmarks and major vascular structures before proceeding with definitive management of the suspected injury. This approach involves careful palpation, gentle retraction, and incremental exposure of the injured area. The rationale is rooted in the fundamental principles of surgical safety and applied surgical anatomy. By systematically identifying and preserving vital structures, the surgeon minimizes the risk of inadvertent damage to adjacent organs, blood vessels, or nerves, which could lead to catastrophic complications. This aligns with the ethical imperative of non-maleficence (do no harm) and beneficence (act in the patient’s best interest) by ensuring the safest possible intervention given the circumstances. Incorrect Approaches Analysis: Proceeding with blind clamping of suspected bleeding vessels without clear anatomical identification is professionally unacceptable. This approach disregards the critical importance of anatomical knowledge and risks ligating essential structures, potentially leading to limb ischemia, organ damage, or even death. It violates the principle of non-maleficence by introducing a high probability of iatrogenic harm. Relying solely on external palpation to guide internal manipulation without direct visualization of the injury site and surrounding anatomy is also professionally unsound. While palpation is a valuable tool, it is insufficient for complex trauma where anatomical distortion is common. This approach increases the likelihood of missing critical structures or causing further injury due to imprecise maneuvers, again contravening the principle of non-maleficence. Attempting to manage the injury by simply packing the wound with gauze to control bleeding without identifying the source is also professionally unacceptable. While temporary hemostasis is important, this method does not address the underlying cause of the bleeding and can mask ongoing hemorrhage, leading to delayed recognition of complications and potentially worsening outcomes. It fails to uphold the principle of beneficence by not providing definitive care and introduces risks of infection and compartment syndrome. Professional Reasoning: Professionals should employ a systematic decision-making process that prioritizes patient safety and evidence-based practice, even in challenging environments. This involves: 1) Thorough pre-operative assessment (even if limited by resources). 2) Application of core surgical principles, emphasizing anatomical knowledge and meticulous technique. 3) Risk-benefit analysis for each step of the procedure, considering available resources. 4) Continuous intraoperative reassessment and adaptation based on findings. 5) Prioritizing identification of critical structures before intervention. 6) Adherence to ethical principles of patient care.