Scenario Analysis: This scenario presents a professional challenge due to the inherent complexity and potential for significant patient harm in advanced colorectal surgery. The need for meticulous pre-operative planning, intra-operative decision-making, and post-operative management requires a surgeon to integrate cutting-edge techniques with established best practices. The ethical imperative to provide the highest standard of care, while respecting patient autonomy and minimizing risk, is paramount. The pressure to adopt novel techniques must be balanced against the need for robust evidence and established safety profiles, especially in a specialized field like complex colorectal surgery where patient outcomes can be drastically affected by surgical choices. Correct Approach Analysis: The best professional practice involves a comprehensive, evidence-based approach to patient selection and surgical planning. This includes a thorough review of the patient’s medical history, imaging, and pathology reports to precisely define the extent of disease and identify any complicating factors. The surgeon should then meticulously plan the surgical approach, considering established techniques and, if novel methods are contemplated, ensuring they are supported by robust clinical evidence and have been performed in a controlled, supervised setting or within a recognized clinical trial framework. This approach prioritizes patient safety and optimal outcomes by leveraging proven methodologies and cautiously integrating new advancements. It aligns with the ethical principles of beneficence and non-maleficence, ensuring that interventions are both beneficial and minimize harm, grounded in a commitment to continuous learning and the highest standards of surgical practice as expected within advanced medical disciplines. Incorrect Approaches Analysis: Adopting a novel surgical technique solely based on anecdotal reports or enthusiasm for new technology, without rigorous evaluation of its safety and efficacy in comparable patient populations, represents a significant ethical and professional failure. This approach disregards the principle of evidence-based medicine and could expose the patient to undue risks associated with unproven methods. Proceeding with a complex procedure without a detailed, individualized pre-operative plan, relying instead on a generalized approach or assuming familiarity with similar cases, is professionally unacceptable. This oversight can lead to intra-operative complications, suboptimal outcomes, and a failure to adequately address the specific anatomical or pathological nuances of the individual patient. It neglects the duty of care to meticulously prepare for each unique surgical challenge. Performing a complex colorectal surgery without adequate consultation or second opinion when faced with unexpected intra-operative findings, particularly if these deviate significantly from the pre-operative assessment, is a critical lapse. This failure to seek collaborative input can result in suboptimal decision-making under pressure, potentially leading to complications that could have been mitigated with broader surgical expertise. Professional Reasoning: Professionals in advanced complex colorectal surgery must adopt a decision-making process that prioritizes patient safety and evidence-based practice. This involves a systematic evaluation of each case, starting with a comprehensive pre-operative assessment and meticulous planning. When considering novel techniques, a critical appraisal of available literature, institutional guidelines, and the surgeon’s own experience and training is essential. A willingness to consult with peers and seek second opinions, especially in challenging or ambiguous situations, is a hallmark of responsible surgical practice. The decision to proceed with any surgical intervention, particularly complex ones, should be a deliberate and informed choice, always placing the patient’s well-being at the forefront.

Scenario Analysis: This scenario presents a professional challenge related to the interpretation and application of eligibility criteria for an advanced surgical qualification. It requires a nuanced understanding of the qualification’s purpose and the specific requirements for candidates seeking to demonstrate their advanced competency in complex colorectal surgery within the Latin American context. Misinterpreting these criteria can lead to inappropriate applications, wasted resources, and potential reputational damage for both the applicant and the qualification body. Careful judgment is required to distinguish between genuine advanced practice and standard surgical experience. Correct Approach Analysis: The best professional approach involves a thorough review of the official documentation outlining the purpose and eligibility for the Advanced Latin American Complex Colorectal Surgery Practice Qualification. This documentation will clearly define the intended scope of the qualification, which is to recognize surgeons who have achieved a level of expertise beyond general colorectal practice, focusing on complex cases and advanced techniques. Eligibility criteria will likely specify a minimum duration of specialized practice, experience with a defined range of complex procedures, and potentially specific training or fellowship requirements. Adhering to these documented requirements ensures that only genuinely qualified candidates are considered, upholding the integrity and standard of the qualification. This aligns with the ethical principle of fairness and the regulatory imperative to maintain high standards in specialized medical practice. Incorrect Approaches Analysis: One incorrect approach would be to assume that any surgeon with a significant number of years in general colorectal practice automatically meets the advanced criteria. This fails to recognize that the qualification specifically targets “complex” surgery, implying a need for specialized skills and experience beyond routine procedures. This approach overlooks the purpose of the qualification, which is to identify a higher tier of expertise. Another incorrect approach would be to focus solely on the number of procedures performed, without considering the complexity or the specific types of complex colorectal surgeries. The qualification’s purpose is not merely about volume but about demonstrated proficiency in challenging cases. This approach would misinterpret eligibility by prioritizing quantity over the qualitative aspect of advanced practice. A further incorrect approach would be to rely on anecdotal evidence or informal recommendations from colleagues without verifying against the official eligibility requirements. While collegial advice can be helpful, it does not substitute for the formal criteria established by the qualification body. This approach risks misrepresenting a candidate’s qualifications and undermines the structured assessment process. Professional Reasoning: Professionals should approach qualification applications by first meticulously consulting the official guidelines and stated purpose of the qualification. They should then objectively assess the applicant’s experience against each specific criterion, looking for evidence of advanced skills, experience with complex cases, and any required specialized training. This systematic, evidence-based approach ensures fairness, upholds professional standards, and maintains the credibility of the qualification.

This scenario presents a professional challenge due to the inherent risks associated with complex colorectal surgery, specifically the potential for unintended tissue damage and the critical need for precise instrument handling and energy device management. Ensuring patient safety necessitates a meticulous approach to operative principles, instrumentation, and energy device safety, directly influenced by established surgical best practices and regulatory guidelines aimed at minimizing harm and optimizing outcomes. The best professional practice involves a systematic and cautious approach to energy device utilization, prioritizing tissue preservation and minimizing collateral thermal injury. This includes thorough pre-operative planning, intra-operative assessment of tissue characteristics, judicious selection of energy modalities and settings, and continuous monitoring of tissue response. Adherence to manufacturer guidelines for each specific energy device and ensuring adequate visualization and insulation are paramount. This approach is ethically mandated by the principle of non-maleficence (do no harm) and is supported by professional surgical standards that emphasize precision and safety in all operative procedures. An incorrect approach would be to rely solely on the surgeon’s experience without rigorous adherence to device-specific protocols or to use energy devices at settings deemed inappropriate for the specific tissue type or surgical field, potentially leading to thermal spread and unintended damage to adjacent structures. This disregards the ethical obligation to employ all available measures to prevent harm and fails to meet the expected standard of care in complex surgical interventions. Another unacceptable approach is to neglect the importance of proper instrument maintenance and selection, such as using damaged insulation on an electrosurgical probe, which can lead to unintended burns and complications, violating the principle of competence and due care. Professionals should employ a decision-making framework that begins with a comprehensive understanding of the patient’s anatomy and pathology, followed by a detailed review of the planned surgical steps. This framework must integrate knowledge of available instrumentation and energy devices, including their specific indications, contraindications, and safety profiles. A critical component is the continuous intra-operative assessment of the surgical field, adapting techniques and device usage based on real-time observations and feedback. This iterative process, grounded in evidence-based practice and ethical considerations, ensures that patient safety remains the absolute priority throughout the procedure.

The control framework reveals a critical juncture in advanced Latin American complex colorectal surgery practice, demanding a nuanced understanding of ethical and professional conduct. The scenario is professionally challenging due to the inherent power imbalance between a senior surgeon and a junior trainee, the potential for patient harm if standards are not upheld, and the need to balance educational objectives with patient safety and institutional reputation. Careful judgment is required to navigate these competing interests. The best approach involves the senior surgeon meticulously documenting the trainee’s performance, including specific areas of strength and weakness, and providing constructive, evidence-based feedback in a private, professional setting. This approach is correct because it directly addresses the need for objective performance evaluation and professional development, aligning with ethical principles of mentorship and patient care. It ensures that feedback is specific, actionable, and delivered in a manner that respects the trainee’s dignity and fosters learning. This aligns with the core principles of professional development and accountability expected within advanced surgical training programs, emphasizing continuous improvement and patient safety as paramount. An incorrect approach would be to dismiss the trainee’s concerns without thorough investigation, citing their junior status as a reason to disregard their observations. This fails to acknowledge the potential for valid concerns regarding surgical technique or patient management, thereby compromising patient safety and undermining the principles of a robust learning environment. It also neglects the ethical obligation to address all feedback, regardless of the source, when it pertains to patient care standards. Another incorrect approach would be to publicly reprimand the trainee in front of the surgical team, highlighting perceived shortcomings without a structured feedback mechanism. This creates a hostile learning environment, discourages open communication, and can have detrimental effects on the trainee’s confidence and future performance. It violates professional conduct by prioritizing public criticism over constructive mentorship and fails to adhere to established protocols for performance evaluation. A further incorrect approach would be to ignore the trainee’s feedback entirely, assuming the senior surgeon’s experience negates any potential for error or improvement. This demonstrates a lack of humility and a failure to embrace the concept of continuous learning, which is essential in complex surgical fields. It also represents a dereliction of duty to ensure the highest standards of patient care and to foster a culture of safety and learning within the surgical team. Professionals should adopt a decision-making framework that prioritizes patient safety, upholds ethical standards, and promotes continuous professional development. This involves actively seeking and thoughtfully considering feedback from all team members, regardless of their seniority. When concerns are raised, a structured process of investigation, objective assessment, and constructive feedback should be implemented. This framework emphasizes transparency, accountability, and a commitment to excellence in both patient care and surgical training.

Scenario Analysis: This scenario presents a significant professional challenge due to the inherent risks associated with complex colorectal surgery, specifically the potential for intraoperative complications like bowel perforation. Managing such a complication requires immediate, decisive action that balances patient safety, surgical integrity, and adherence to established protocols. The surgeon must navigate the immediate need for intervention with the long-term implications for patient recovery and potential legal or ethical scrutiny. Careful judgment is required to select the most appropriate course of action that minimizes harm and maximizes the chances of a successful outcome. Correct Approach Analysis: The best professional practice involves immediate, direct communication with the surgical team to assess the extent of the perforation and collaboratively determine the most appropriate surgical management. This includes discussing options such as immediate repair, diversion, or conversion to a more definitive procedure, all while considering the patient’s physiological status. This approach is correct because it prioritizes patient safety by addressing the complication directly and promptly. It aligns with the ethical principles of beneficence (acting in the patient’s best interest) and non-maleficence (avoiding harm). Furthermore, it adheres to professional standards of care which mandate clear communication and collaborative decision-making in critical surgical situations. This ensures that all available expertise is leveraged to achieve the best possible outcome for the patient. Incorrect Approaches Analysis: One incorrect approach involves delaying definitive management to consult with a senior colleague not immediately present, without first stabilizing the situation or initiating preliminary steps to address the perforation. This failure to act decisively in the face of an intraoperative emergency can lead to increased contamination, sepsis, and poorer patient outcomes, violating the principle of beneficence. It also demonstrates a lack of professional responsibility to manage immediate surgical crises. Another incorrect approach is to attempt a complex repair without adequate visualization or resources, or to proceed with the original operative plan as if the perforation did not occur. This is professionally unacceptable as it knowingly disregards a critical intraoperative event, potentially leading to severe morbidity or mortality. It represents a failure to uphold the duty of care and a disregard for patient safety. A further incorrect approach is to document the perforation but proceed with closure without any attempt at repair or diversion, relying solely on postoperative antibiotics. This is a grave ethical and professional failing. It abandons the patient to a preventable complication and demonstrates a complete disregard for established surgical principles and patient well-being. Professional Reasoning: Professionals should employ a structured approach to managing intraoperative complications. This involves: 1) immediate recognition and assessment of the complication; 2) clear and concise communication with the surgical team; 3) collaborative decision-making regarding management options, considering patient factors and available resources; 4) prompt implementation of the chosen management strategy; and 5) thorough documentation and postoperative follow-up. This systematic process ensures that patient safety is paramount and that all actions are ethically sound and professionally defensible.

This scenario presents a professional challenge due to the inherent tension between a candidate’s desire to progress in their career and the institution’s need to maintain rigorous standards for patient safety and professional competence. The weighting, scoring, and retake policies are designed to ensure that only highly qualified surgeons are certified, directly impacting patient outcomes. Careful judgment is required to balance fairness to the individual with the overarching responsibility to public health. The best professional approach involves a transparent and consistent application of the established blueprint weighting, scoring, and retake policies. This means that all candidates are assessed against the same criteria, and any deviations or special considerations are documented and justified according to pre-defined institutional guidelines. The weighting of different assessment components, the threshold for passing scores, and the conditions under which a retake is permitted are all critical elements of the qualification process. Adhering strictly to these policies ensures fairness, objectivity, and the integrity of the qualification. This approach is ethically sound as it upholds the principle of justice by treating all candidates equally and is regulatory compliant by following the established framework for assessment. An incorrect approach would be to allow subjective influence on the scoring or retake eligibility based on factors outside the established policies, such as the candidate’s perceived effort or personal circumstances not covered by policy. This undermines the objectivity of the assessment and can lead to perceptions of favoritism or bias, eroding trust in the qualification process. It also fails to uphold the regulatory requirement for standardized and equitable assessment. Another incorrect approach is to arbitrarily change the weighting or scoring thresholds for a specific candidate without a formal, documented review process that aligns with institutional policy. This not only compromises the integrity of the assessment but also creates a precedent for inconsistent application of standards, potentially leading to legal or ethical challenges. It directly violates the principle of fairness and the regulatory mandate for clear and consistently applied assessment criteria. Finally, an incorrect approach would be to grant a retake opportunity without meeting the explicit criteria outlined in the retake policy, such as a failing score or specific extenuating circumstances. This devalues the qualification process and could result in individuals who have not demonstrated the required level of competence being certified, posing a risk to patient safety. It is a failure to adhere to the established regulatory framework governing qualification and professional standards. Professionals should approach such situations by first thoroughly understanding the institution’s established policies regarding blueprint weighting, scoring, and retake procedures. They should then apply these policies consistently and impartially to all candidates. If there are ambiguities or potential exceptions, these should be addressed through a formal review process involving relevant committees or supervisors, ensuring that any decisions are well-documented and justifiable within the regulatory framework. Transparency with candidates about these policies is also crucial.

Scenario Analysis: This scenario presents a professional challenge for a surgeon preparing for an advanced qualification in Latin American Complex Colorectal Surgery. The core difficulty lies in balancing the need for comprehensive, up-to-date knowledge with the practical constraints of a busy surgical schedule and the diverse learning styles and resource availability within the Latin American region. Effective preparation requires not only mastering complex surgical techniques but also understanding the specific regulatory and ethical frameworks governing surgical practice and continuing professional development in the target region. Careful judgment is required to select preparation methods that are both effective and compliant with regional standards. Correct Approach Analysis: The best approach involves a structured, multi-modal preparation strategy that integrates theoretical study with practical application, specifically tailored to the Latin American context. This includes dedicating specific, protected time slots for studying peer-reviewed literature, attending regional and international congresses focused on colorectal surgery, and engaging in simulation-based training. Crucially, this approach prioritizes resources that are recognized by Latin American surgical societies and regulatory bodies, ensuring that the knowledge acquired is relevant and aligned with local practice standards and ethical guidelines. This method acknowledges the importance of continuous learning and adaptation within the specific professional environment. Incorrect Approaches Analysis: Relying solely on a single, outdated textbook without incorporating recent advancements or regional specificities is professionally inadequate. This fails to address the dynamic nature of complex colorectal surgery and ignores the need for current best practices and evolving ethical considerations prevalent in Latin America. Focusing exclusively on attending general surgical conferences that do not have a specific emphasis on complex colorectal surgery or the Latin American context would lead to a superficial understanding. This approach lacks the depth required for advanced qualification and may not cover the specific regulatory nuances or ethical challenges pertinent to the region. Prioritizing only on-the-job learning without structured study or formal preparation resources is also problematic. While practical experience is vital, it may not systematically cover all aspects of complex colorectal surgery or ensure adherence to the latest evidence-based guidelines and ethical standards mandated by Latin American regulatory frameworks. This can lead to knowledge gaps and potential deviations from best practices. Professional Reasoning: Professionals facing similar preparation challenges should adopt a systematic decision-making process. First, identify the specific learning objectives and the scope of the qualification. Second, research and evaluate available preparation resources, prioritizing those that are current, evidence-based, and relevant to the target geographical and professional context (in this case, Latin America). Third, assess personal learning style and time constraints to create a realistic and balanced study plan. Fourth, seek guidance from mentors or senior colleagues who have successfully navigated similar qualifications. Finally, ensure that the chosen preparation methods align with the ethical principles and regulatory requirements of the relevant professional bodies.

Scenario Analysis: This scenario is professionally challenging due to the immediate life-threatening nature of severe trauma and the critical need for rapid, evidence-based intervention. The complexity arises from the potential for multiple organ system involvement, the need for coordinated multidisciplinary care, and the ethical imperative to provide the highest standard of care while respecting patient autonomy and resource limitations. Navigating the nuances of advanced resuscitation protocols in a high-pressure environment demands not only clinical expertise but also a thorough understanding of established guidelines and ethical considerations. Correct Approach Analysis: The best professional practice involves initiating a structured, systematic resuscitation protocol based on current international trauma guidelines, such as the Advanced Trauma Life Support (ATLS) principles, adapted to the specific clinical context. This approach prioritizes immediate life-saving interventions, including airway management, breathing support, circulation restoration, and disability assessment, followed by a thorough exposure and environmental control. This systematic approach ensures that critical injuries are identified and addressed promptly, minimizing the risk of preventable mortality and morbidity. Adherence to these established protocols is ethically mandated to provide the best possible patient outcome and is often implicitly or explicitly supported by professional medical bodies and institutional policies that define the standard of care. Incorrect Approaches Analysis: One incorrect approach involves delaying definitive resuscitation measures to conduct an exhaustive diagnostic workup, such as extensive imaging or laboratory tests, before initiating critical interventions. This deviates from established trauma protocols by prioritizing diagnostic certainty over immediate life support, potentially leading to irreversible physiological compromise and increased mortality. Ethically, this approach fails to uphold the principle of beneficence by not acting swiftly to alleviate suffering and prevent harm. Another incorrect approach is to focus solely on managing one apparent injury without a comprehensive assessment of the entire patient. This narrow focus can lead to overlooking other life-threatening injuries that may not be immediately obvious, resulting in delayed or missed diagnoses and suboptimal outcomes. This violates the principle of non-maleficence by potentially causing harm through omission and fails to meet the standard of comprehensive care expected in trauma management. A further incorrect approach is to deviate significantly from established resuscitation algorithms without clear clinical justification or consultation, perhaps based on anecdotal experience or personal preference. This introduces an element of unpredictability and potentially suboptimal care, undermining the evidence-based foundation of trauma management. It raises ethical concerns regarding accountability and the consistent application of best practices across all patients. Professional Reasoning: Professionals should employ a decision-making framework that prioritizes rapid assessment and intervention guided by established, evidence-based protocols. This involves a continuous cycle of assessment, intervention, and reassessment, with a focus on identifying and managing immediate threats to life. Multidisciplinary communication and collaboration are crucial, ensuring that all team members are aware of the patient’s status and the ongoing management plan. Ethical considerations, including patient advocacy, resource allocation, and informed consent (when possible), should be integrated into the decision-making process.

Scenario Analysis: This scenario is professionally challenging because it involves a complex colorectal surgery with a patient presenting with multiple comorbidities, increasing the inherent risks. The surgeon must balance the need for definitive treatment with the patient’s physiological limitations and potential for complications. Effective structured operative planning with robust risk mitigation is paramount to ensure patient safety and optimize outcomes, while also adhering to professional standards and ethical obligations. Correct Approach Analysis: The best professional practice involves a comprehensive, multidisciplinary pre-operative assessment and detailed operative plan that explicitly addresses the identified risks. This includes a thorough review of the patient’s medical history, current medications, and previous surgical outcomes. The operative plan should outline specific strategies for managing each comorbidity during surgery, such as intraoperative fluid management for renal impairment or careful anesthetic titration for cardiac conditions. Furthermore, the plan must detail contingency measures for potential intraoperative complications, including clear communication protocols with the surgical team and anesthesiologist, and readily available resources for managing adverse events. This structured approach aligns with the ethical principles of beneficence and non-maleficence, ensuring that all reasonable steps are taken to maximize benefit and minimize harm. It also reflects the professional obligation to provide care that is evidence-based and tailored to the individual patient’s needs. Incorrect Approaches Analysis: Proceeding with a standard operative plan without specific modifications for the patient’s comorbidities and without detailed contingency planning for potential complications is professionally unacceptable. This approach fails to adequately address the increased risks associated with the patient’s complex medical profile, potentially leading to preventable adverse events. It demonstrates a lack of due diligence in risk assessment and mitigation, violating the principle of non-maleficence. Relying solely on the surgical team’s collective experience during the operation to manage unforeseen complications, without prior structured planning and discussion, is also professionally inadequate. While experience is valuable, it should supplement, not replace, a pre-operative, structured risk assessment and mitigation strategy. This reactive approach increases the likelihood of delayed or suboptimal management of complications, potentially compromising patient safety and violating the duty of care. Focusing exclusively on the technical aspects of the surgery and deferring all risk management considerations to the anesthesiologist overlooks the surgeon’s primary responsibility in patient care and operative planning. While collaboration with anesthesia is crucial, the surgeon bears the ultimate responsibility for the overall operative plan, including anticipating and mitigating surgical-specific risks. This siloed approach can lead to communication breakdowns and missed opportunities for comprehensive risk management. Professional Reasoning: Professionals should adopt a systematic approach to operative planning, particularly in complex cases. This involves: 1. Comprehensive Patient Assessment: Thoroughly understanding the patient’s medical history, comorbidities, and previous surgical experiences. 2. Multidisciplinary Collaboration: Engaging with relevant specialists (e.g., cardiology, nephrology, anesthesia) to optimize pre-operative management and inform the operative plan. 3. Structured Operative Planning: Developing a detailed plan that includes surgical steps, anticipated challenges, and specific strategies for managing identified risks. 4. Risk Mitigation Strategies: Proactively identifying potential complications and outlining clear contingency plans, including communication protocols and resource allocation. 5. Team Briefing: Ensuring all members of the surgical team are aware of the operative plan, potential risks, and their roles in managing complications. 6. Continuous Evaluation: Monitoring the patient’s condition throughout the procedure and adapting the plan as necessary.

This scenario presents a professional challenge due to the inherent tension between patient autonomy, the surgeon’s clinical judgment, and the need for clear, documented communication within a complex surgical team. The requirement for informed consent in Latin American jurisdictions, particularly concerning advanced procedures like complex colorectal surgery, is stringent and rooted in ethical principles of patient self-determination and legal mandates for patient rights. Careful judgment is required to navigate potential disagreements and ensure all parties are aligned and protected. The best approach involves a structured, documented discussion with the patient, clearly outlining the proposed surgical plan, including potential variations and their implications, and ensuring the patient’s understanding and explicit consent to these contingencies. This aligns with the ethical imperative of respecting patient autonomy and the legal requirement for comprehensive informed consent. Specifically, in many Latin American legal frameworks, informed consent is not a one-time event but an ongoing process, requiring clear communication of risks, benefits, alternatives, and the potential for unforeseen circumstances during surgery. Documenting this discussion, including any patient questions and the surgeon’s responses, provides a crucial record of due diligence and adherence to professional standards. An incorrect approach would be to proceed with the surgery based on a presumed understanding or a brief verbal confirmation without a detailed discussion of potential intraoperative findings and necessary deviations. This fails to uphold the principle of informed consent, as the patient has not been adequately apprised of the full spectrum of possibilities, including those that might arise from unexpected intraoperative findings. Ethically, this undermines patient autonomy, and legally, it could be construed as a breach of the duty to inform, potentially leading to legal repercussions. Another incorrect approach would be to unilaterally decide on significant deviations from the initial surgical plan during the procedure without attempting to re-engage the patient or their designated representative for consent, unless it is a clear, life-saving emergency where such communication is impossible. While emergencies necessitate swift action, the justification for deviating from the agreed-upon plan must be robust and documented. Failing to do so, when possible, neglects the patient’s right to be informed about substantial changes to their care. A further incorrect approach would be to rely solely on the surgical team’s consensus without ensuring the patient has fully grasped the implications of the proposed surgical variations. While team collaboration is vital, the ultimate responsibility for obtaining informed consent rests with the operating surgeon. Overlooking the patient’s comprehension in favor of team agreement neglects the core ethical and legal obligations. Professionals should employ a decision-making framework that prioritizes patient-centered care. This involves: 1) Thorough pre-operative assessment and planning. 2) Comprehensive, clear, and understandable communication with the patient regarding the procedure, including potential variations and their rationale. 3) Active listening to patient concerns and questions, ensuring genuine understanding. 4) Detailed documentation of all discussions and consent obtained. 5) Continuous assessment during surgery, with clear protocols for addressing unexpected findings and re-engaging the patient or their representative for consent when feasible and appropriate, prioritizing patient autonomy at all stages.