System analysis indicates that managing complex hepatopancreatobiliary (HPB) surgical cases requires adherence to advanced practice standards that extend beyond general surgical principles. This scenario is professionally challenging due to the inherent complexity of HPB anatomy, the high risk of perioperative complications, and the need for meticulous, multidisciplinary care. The patient’s pre-existing comorbidities and the emergent nature of the presentation necessitate a highly coordinated and evidence-based approach, demanding precise decision-making under pressure. The correct approach involves immediate multidisciplinary team consultation and a thorough, systematic pre-operative assessment to stabilize the patient and formulate a comprehensive surgical plan. This includes engaging anesthesiology, critical care, and relevant surgical subspecialties (e.g., interventional radiology, gastroenterology) to address the patient’s hemodynamic instability and potential for rapid deterioration. The rationale for this approach is rooted in established best practices for managing critically ill surgical patients, emphasizing patient safety, risk mitigation, and optimizing outcomes through collaborative expertise. This aligns with the ethical imperative to provide the highest standard of care and the professional responsibility to leverage all available resources for patient benefit. An incorrect approach would be to proceed with surgery without adequate pre-operative stabilization and multidisciplinary input. This fails to address the patient’s critical condition, significantly increasing the risk of intraoperative and postoperative complications, such as uncontrolled bleeding, organ dysfunction, and prolonged recovery. Ethically, this demonstrates a disregard for patient safety and a failure to adhere to the principle of beneficence. Another incorrect approach would be to delay definitive surgical management indefinitely due to the patient’s comorbidities, opting solely for conservative measures without a clear plan for eventual intervention or palliation. This may lead to progressive disease, increased suffering, and missed opportunities for potentially curative or life-prolonging treatment, violating the principle of non-maleficence by allowing harm to occur through inaction. A further incorrect approach would be to delegate the primary surgical decision-making and management to a less experienced surgeon without adequate senior oversight or consultation, particularly given the emergent and complex nature of the case. This compromises patient safety by not ensuring that the most qualified expertise is leading the care, potentially leading to suboptimal surgical technique or management errors, and failing to uphold the professional duty of care. Professionals should employ a structured decision-making process that prioritizes patient safety and evidence-based practice. This involves: 1) Rapidly assessing the patient’s immediate physiological status and identifying critical risks. 2) Actively seeking and integrating input from all relevant specialties to create a holistic understanding of the patient’s condition and potential treatment pathways. 3) Developing a phased management plan that addresses immediate stabilization, surgical intervention, and postoperative care, with clear contingency plans for potential complications. 4) Ensuring clear communication and shared decision-making among the care team and, where appropriate, with the patient and their family.

Scenario Analysis: This scenario is professionally challenging because it involves a surgeon with extensive experience but lacking the specific, formal credentialing required by the Pan-Asia Hepatopancreatobiliary Surgery Licensure Examination. The pressure to operate on complex cases, coupled with the desire to maintain a reputation for expertise, can lead to a temptation to bypass established procedures. Careful judgment is required to balance patient care with adherence to regulatory frameworks designed to ensure competence and patient safety. Correct Approach Analysis: The best professional practice involves diligently pursuing the formal eligibility requirements for the Advanced Pan-Asia Hepatopancreatobiliary Surgery Licensure Examination. This approach prioritizes adherence to the established regulatory framework, which mandates specific training, experience, and examination criteria for licensure. The purpose of the examination is to standardize and verify advanced competency in a highly specialized field, ensuring that all licensed surgeons meet a defined benchmark of knowledge and skill. By actively seeking to meet these criteria, the surgeon demonstrates a commitment to patient safety and professional integrity, aligning with the ethical obligation to practice within the scope of one’s validated qualifications. Incorrect Approaches Analysis: One incorrect approach involves attempting to leverage existing, albeit informal, recognition of expertise to bypass the formal examination process. This fails to acknowledge that the licensure examination serves as the definitive regulatory mechanism for validating advanced competency in Pan-Asia Hepatopancreatobiliary Surgery. Relying solely on anecdotal evidence of success or peer reputation, without formal assessment, contravenes the purpose of the licensure, which is to provide an objective and standardized measure of qualification. This approach risks patient safety by operating without the explicit regulatory approval that the examination confers. Another incorrect approach is to argue for an exemption based on the perceived inadequacy of the examination for highly experienced surgeons. While the examination’s design is a matter for the regulatory body, individual surgeons are bound by its requirements. Arguing for personal exemption undermines the principle of equitable application of regulations, which are designed to protect the public. The eligibility criteria are established to ensure a baseline level of competence for all practitioners in this specialized field, regardless of prior experience. A further incorrect approach is to seek a provisional license based on the intention to take the exam at a later date, without meeting any of the preliminary eligibility criteria. Licensure examinations typically have defined prerequisites that must be met before an individual can even be considered for examination. This approach disregards the structured pathway established by the regulatory framework, which is designed to ensure that candidates are adequately prepared before undertaking the assessment. It prioritizes expediency over the rigorous process designed to safeguard public health. Professional Reasoning: Professionals facing such a dilemma should employ a decision-making framework that prioritizes regulatory compliance and patient safety. This involves: 1) Understanding the explicit purpose and eligibility requirements of the relevant licensure examination. 2) Honestly assessing one’s own qualifications against these requirements. 3) If eligibility is not met, developing a clear, actionable plan to achieve it, which may involve further training, supervised practice, or specific experience. 4) Consulting with professional bodies or regulatory authorities for clarification on requirements and pathways. 5) Prioritizing ethical obligations to patients, which includes practicing only within the scope of one’s validated credentials.

The assessment process reveals a scenario that is professionally challenging due to the inherent risks associated with complex hepatopancreatobiliary surgery, specifically the potential for significant intraoperative bleeding and thermal injury. The surgeon must balance the need for meticulous dissection and hemostasis with the efficient application of energy devices to minimize operative time and tissue trauma. Careful judgment is required to select the appropriate energy device, optimize its settings, and apply it safely and effectively, all while adhering to established surgical protocols and patient safety standards. The correct approach involves a systematic and evidence-based strategy for energy device utilization. This includes pre-operative planning to anticipate potential challenges and select the most appropriate device for the specific surgical field and tissue type. During the procedure, the surgeon must employ a “spray” or “coagulation” mode for diffuse bleeding, using short bursts and maintaining adequate distance from critical structures. For precise dissection, a “cutting” or “blend” mode should be used with direct contact and controlled application. The use of a return electrode (grounding pad) placed on a large, well-vascularized area, away from bony prominences and implants, is paramount to prevent unintended thermal injury. This approach aligns with established surgical best practices and ethical obligations to minimize patient harm and maximize patient benefit, as underscored by general principles of patient safety and professional conduct in surgical practice. An incorrect approach would be to indiscriminately use a high-power setting or a single energy mode for all tasks, regardless of the tissue type or the presence of critical structures. This disregards the principle of using the least destructive effective modality and increases the risk of thermal spread, causing collateral damage to adjacent organs, nerves, or blood vessels. Another failure would be improper placement or monitoring of the grounding pad, which can lead to capacitive coupling or direct coupling burns at unintended sites, a clear violation of patient safety protocols. Furthermore, relying solely on the visual feedback of smoke without understanding the underlying mechanism of energy delivery and its potential for thermal diffusion represents a lack of technical proficiency and a failure to adhere to safe operative principles. Professionals should employ a decision-making framework that prioritizes patient safety and evidence-based practice. This involves a thorough understanding of the principles of electrosurgery, including the different modes of energy delivery and their effects on various tissues. Pre-operative assessment should include a review of imaging to identify critical structures and potential anatomical variations. Intraoperatively, constant vigilance regarding energy device application, including appropriate power settings, mode selection, and grounding pad management, is essential. A commitment to continuous learning and adherence to institutional policies and professional guidelines will ensure the safest and most effective surgical outcomes.

The evaluation methodology shows that managing a patient with severe hepatopancreatobiliary trauma in a critical care setting presents significant professional challenges due to the complexity of injuries, the potential for rapid hemodynamic decompensation, and the need for immediate, coordinated multidisciplinary intervention. Careful judgment is required to balance aggressive resuscitation with the avoidance of iatrogenic complications and to ensure adherence to established protocols. The correct approach involves immediate, aggressive fluid resuscitation with balanced crystalloids, coupled with early administration of blood products in a balanced ratio (e.g., 1:1:1 packed red blood cells, fresh frozen plasma, and platelets) to address coagulopathy and hemorrhagic shock. This is guided by continuous hemodynamic monitoring and frequent reassessment of the patient’s response. This strategy is supported by established trauma resuscitation guidelines, such as those promoted by the American College of Surgeons Committee on Trauma, which emphasize the importance of early reversal of coagulopathy and maintaining adequate tissue perfusion to prevent organ failure. Ethically, this approach prioritizes the patient’s immediate survival and well-being by addressing the most life-threatening issues first. An incorrect approach would be to solely rely on crystalloid resuscitation without early consideration of blood products. This can lead to dilution of clotting factors and platelets, exacerbating coagulopathy and prolonging resuscitation efforts, potentially resulting in a worse outcome. This fails to adhere to current best practices in massive transfusion protocols and can be seen as a deviation from the ethical imperative to provide optimal care. Another incorrect approach would be to delay definitive surgical exploration and source control while continuing aggressive, unguided resuscitation. While resuscitation is critical, prolonged resuscitation without addressing the source of bleeding or contamination can lead to further physiological derangement and increased morbidity. This can be considered a failure to act decisively and can violate the principle of timely intervention in trauma care. Finally, an incorrect approach would be to administer blood products without adequate monitoring or a clear resuscitation endpoint, leading to potential complications such as transfusion-related acute lung injury (TRALI) or fluid overload. This demonstrates a lack of precise application of resuscitation principles and can be ethically problematic if it leads to patient harm. Professionals should employ a structured decision-making process that begins with a rapid primary survey (Airway, Breathing, Circulation, Disability, Exposure) to identify life threats. This is followed by a secondary survey and the initiation of resuscitation protocols tailored to the patient’s presentation. Continuous reassessment of the patient’s response to interventions, coupled with clear communication among the trauma team (surgeons, anesthesiologists, intensivists, nurses, and blood bank personnel), is paramount. Adherence to evidence-based guidelines and institutional protocols for trauma resuscitation and massive transfusion is essential for optimal patient outcomes.

This scenario is professionally challenging due to the immediate and potentially life-threatening nature of a post-operative complication, coupled with the need for rapid, informed decision-making under pressure. The surgeon must balance the urgency of the patient’s condition with the ethical imperative to obtain informed consent and adhere to established protocols for managing such events. Careful judgment is required to differentiate between expected post-operative sequelae and a true complication requiring intervention, and to communicate effectively with the patient and their family. The best approach involves immediate, thorough assessment of the patient’s clinical status to confirm the presence and severity of the suspected complication. This assessment should be followed by prompt, clear, and comprehensive communication with the patient and/or their designated surrogate regarding the findings, potential causes, and proposed management options, including risks, benefits, and alternatives. Obtaining informed consent for any necessary intervention is paramount. This aligns with fundamental ethical principles of patient autonomy and beneficence, as well as regulatory requirements for patient care and documentation. The principle of “do no harm” necessitates a proactive and transparent approach to managing complications. An incorrect approach would be to proceed with a re-operation or invasive intervention without first confirming the complication through a systematic assessment and without obtaining informed consent. This violates the principle of patient autonomy and could lead to unnecessary procedures with associated risks. It also fails to meet the standard of care for managing post-operative complications, which mandates a thorough diagnostic workup before surgical intervention. Another incorrect approach would be to delay necessary intervention due to concerns about patient distress or the complexity of obtaining consent in an emergency. While patient comfort is important, delaying critical care for a confirmed complication can lead to irreversible harm and is ethically indefensible. Regulatory frameworks emphasize timely and appropriate medical care. Finally, an incorrect approach would be to delegate the responsibility of informing the patient and obtaining consent to junior staff without adequate supervision or to proceed with a vague or incomplete explanation of the situation and proposed treatment. This undermines the surgeon’s ultimate responsibility for patient care and informed consent, and can lead to misunderstandings and a breakdown of trust. The professional reasoning process in such situations should involve a structured approach: first, stabilize the patient if necessary; second, conduct a rapid but thorough diagnostic assessment; third, clearly and honestly communicate findings and options to the patient/surrogate; fourth, obtain informed consent for the chosen course of action; and fifth, execute the agreed-upon treatment plan with meticulous care and documentation.

Scenario Analysis: This scenario presents a common challenge in professional licensure and ongoing competency assessment. The core difficulty lies in balancing the need for rigorous evaluation of surgical skills and knowledge with the practical realities of a surgeon’s career, including potential periods of reduced activity or the need to demonstrate continued proficiency. The examination board must uphold the integrity of the licensure while also providing a fair and transparent process for candidates. The weighting and scoring of the examination, as well as the retake policies, are critical components that directly impact a surgeon’s ability to practice and their career progression. Misinterpretation or misapplication of these policies can lead to significant professional and personal consequences for the surgeon, and potentially compromise patient safety if standards are not maintained. Correct Approach Analysis: The best approach involves a thorough understanding and strict adherence to the established Blueprint weighting, scoring, and retake policies as outlined by the Advanced Pan-Asia Hepatopancreatobiliary Surgery Licensure Examination Board. This means meticulously reviewing the official documentation that details how different sections of the examination contribute to the overall score, the specific passing thresholds, and the conditions under which a candidate may retake the examination. This approach is correct because it is grounded in the explicit rules and regulations governing the licensure. It ensures fairness, consistency, and transparency in the evaluation process, minimizing subjective interpretation and potential bias. Adhering to these policies is an ethical imperative for both the candidate and the examination board, as it upholds the standards of the profession and protects public safety. Incorrect Approaches Analysis: One incorrect approach is to assume that a minor deviation from the stated scoring criteria, such as a slight overperformance in one section compensating for a marginal underperformance in another, would be acceptable without explicit policy allowance. This is professionally unacceptable because it undermines the standardized nature of the examination. The Blueprint weighting is designed to ensure a balanced assessment across all critical domains; circumventing this by subjective adjustment introduces an element of arbitrariness and can lead to a candidate being deemed competent when they may not have met the minimum standards in all required areas. Another incorrect approach is to rely on anecdotal evidence or informal discussions with past candidates or examiners regarding retake eligibility or scoring nuances. This is professionally unsound because it bypasses the official, authoritative source of information. Policies are subject to change, and individual interpretations can be inaccurate or outdated. Basing decisions on hearsay rather than official documentation risks misinterpreting the requirements, leading to incorrect assumptions about one’s performance or eligibility for future attempts, and potentially causing significant disappointment and wasted effort. A further incorrect approach is to argue for a special exemption from standard retake policies based on personal circumstances, such as a demanding clinical schedule or a perceived unfairness in a specific question. While personal circumstances can be challenging, the examination policies are designed to be applied uniformly to all candidates to maintain equity. Arguing for an exemption without a formal appeals process outlined in the policies, or without demonstrating a significant procedural error by the examination board, is unlikely to be successful and demonstrates a lack of understanding of the professional accountability inherent in licensure examinations. Professional Reasoning: Professionals facing such situations should adopt a systematic decision-making process. First, they must identify and consult the official documentation governing the examination, specifically the Blueprint, scoring rubrics, and retake policies. Second, they should interpret these documents literally and without subjective embellishment. Third, if there is any ambiguity, they should seek clarification directly from the examination board through their designated official channels. Fourth, they must understand that adherence to established policies is paramount for maintaining professional integrity and ensuring fair assessment for all. Finally, they should be prepared to accept the outcomes of the examination based on these established policies, while understanding the formal avenues for appeal if a genuine procedural irregularity is suspected.

The analysis reveals a complex clinical and professional challenge stemming from a potential conflict between patient autonomy, the surgeon’s perceived best interest for the patient, and the established protocols for managing complex hepatopancreatobiliary (HPB) cases. The surgeon is faced with a situation where a patient, despite having a clear understanding of the risks and benefits of a complex HPB procedure, expresses a strong preference for a less invasive, potentially less curative option due to significant anxiety about the morbidity associated with the optimal surgical approach. This scenario demands careful navigation of ethical principles, professional responsibilities, and adherence to established guidelines for patient care and surgical decision-making. The correct approach involves a structured, multidisciplinary discussion that prioritizes shared decision-making while ensuring the patient’s understanding of all viable options and their implications. This entails a thorough re-evaluation of the patient’s understanding of the risks, benefits, and alternatives, including the potential long-term consequences of each choice. Crucially, it requires engaging other specialists, such as oncologists, gastroenterologists, and palliative care physicians, to provide a comprehensive perspective and support the patient in making an informed decision. This collaborative approach ensures that the patient’s values and preferences are central to the decision-making process, while also upholding the surgeon’s duty to provide the best possible medical advice. This aligns with the ethical imperative of respecting patient autonomy and the professional obligation to practice evidence-based medicine within a framework of shared decision-making, as often emphasized in professional surgical guidelines and patient rights charters. An incorrect approach would be to proceed with the patient’s preferred less invasive option without a thorough exploration of the underlying reasons for their anxiety and without ensuring they fully comprehend the potential trade-offs in terms of oncological outcomes or long-term quality of life. This bypasses the essential step of addressing the patient’s fears and anxieties, potentially leading to a suboptimal outcome and a failure to uphold the surgeon’s duty of care. Another professionally unacceptable approach would be to dismiss the patient’s concerns and insist on the more aggressive surgical plan, disregarding their expressed wishes and autonomy. This constitutes a paternalistic stance that undermines the patient’s right to self-determination in their medical care. Finally, unilaterally deciding on a course of action without adequate consultation or documentation of the shared decision-making process would also be professionally unsound, as it fails to demonstrate due diligence and collaborative care. Professionals should approach such situations by first acknowledging and validating the patient’s emotional state and concerns. This should be followed by a systematic process of information sharing, ensuring clarity on all aspects of the proposed treatments. Engaging a multidisciplinary team provides a robust support system for both the patient and the surgical team, facilitating a more comprehensive and ethically sound decision. The decision-making framework should be rooted in the principles of beneficence, non-maleficence, autonomy, and justice, with a strong emphasis on open communication and shared responsibility.

The risk matrix shows a moderate likelihood of a candidate experiencing burnout due to the demanding nature of preparing for the Advanced Pan-Asia Hepatopancreatobiliary Surgery Licensure Examination. This scenario is professionally challenging because it requires balancing rigorous academic preparation with personal well-being, a common dilemma for highly specialized medical professionals. Careful judgment is required to ensure that preparation is effective without compromising the candidate’s health or the quality of patient care they might be providing concurrently. The best approach involves a structured, phased preparation plan that integrates study with regular breaks and self-care activities. This strategy acknowledges the extensive knowledge base required for the examination and the need for sustained cognitive function. By allocating specific time blocks for study, review, and practice questions, and crucially, scheduling periods for rest, exercise, and social engagement, the candidate can mitigate burnout. This aligns with ethical principles of professional responsibility, which include maintaining one’s own health to ensure competence and patient safety. Furthermore, professional development guidelines often emphasize sustainable learning practices. An approach that focuses solely on intensive, uninterrupted study for an extended period, neglecting rest and personal well-being, is professionally unacceptable. This method ignores the physiological and psychological limits of human learning and endurance, increasing the risk of burnout, reduced information retention, and impaired decision-making. It fails to adhere to the implicit ethical obligation to maintain one’s health for the benefit of future patients. Another professionally unacceptable approach is to delay comprehensive preparation until immediately before the examination. This reactive strategy often leads to superficial learning, increased anxiety, and a higher likelihood of failure. It demonstrates a lack of foresight and professional discipline, potentially impacting the candidate’s ability to practice safely and competently. Finally, relying exclusively on passive learning methods like simply reading textbooks without active recall or practice scenarios is also problematic. While reading is a component of preparation, it does not adequately simulate the diagnostic and decision-making challenges of an advanced surgical licensure exam. This approach can lead to a false sense of preparedness and a failure to identify knowledge gaps effectively, which is a disservice to the candidate and the profession. Professionals should employ a proactive, balanced approach to licensure preparation. This involves creating a realistic study schedule that incorporates diverse learning methods, regular self-assessment, and dedicated time for rest and rejuvenation. Seeking guidance from mentors or peers who have successfully navigated similar examinations can also provide valuable insights into effective preparation strategies.

Scenario Analysis: This scenario is professionally challenging because it involves a critical decision with potential patient safety implications, balancing immediate resource needs with established protocols and the need for thorough assessment. The surgeon’s personal experience, while valuable, must be weighed against objective data and institutional guidelines to ensure the highest standard of care. Careful judgment is required to avoid both unnecessary delays and premature interventions. Correct Approach Analysis: The best professional practice involves a systematic approach that prioritizes patient safety and adherence to established protocols. This includes a comprehensive review of all available diagnostic data, consultation with relevant specialists, and a thorough pre-operative assessment. This approach ensures that the decision to proceed with surgery is based on the most complete and objective information, minimizing risks and maximizing the likelihood of a successful outcome. It aligns with ethical principles of beneficence and non-maleficence, as well as regulatory requirements for due diligence in surgical decision-making. Incorrect Approaches Analysis: Proceeding with surgery based solely on the surgeon’s strong clinical suspicion and the patient’s reported symptoms, without a complete review of imaging and laboratory results, represents a failure to adhere to established diagnostic and pre-operative assessment protocols. This approach risks operating on an incorrect diagnosis or overlooking critical contraindications, violating the principle of non-maleficence and potentially leading to adverse patient outcomes. It also bypasses necessary institutional checks and balances designed to ensure patient safety. Delaying surgery indefinitely due to the absence of a definitive diagnosis, despite strong clinical indicators and the patient’s worsening condition, is also professionally unacceptable. This approach fails to act with appropriate urgency when a patient’s health is at risk, potentially violating the principle of beneficence. It also neglects the surgeon’s responsibility to advocate for the patient and pursue all reasonable diagnostic avenues to facilitate timely and appropriate treatment. Consulting only with a junior colleague for a second opinion, without involving senior or subspecialty expertise, is insufficient for a complex hepatopancreatobiliary case. This approach may not provide the breadth of knowledge or experience necessary to make a fully informed decision, potentially leading to suboptimal management and failing to meet the standard of care expected in such specialized fields. Professional Reasoning: Professionals should employ a structured decision-making framework that begins with a thorough understanding of the patient’s condition, followed by a comprehensive review of all available data. This includes diagnostic imaging, laboratory results, and patient history. Next, consultation with appropriate colleagues, including subspecialists, should be sought to gain diverse perspectives. The decision-making process should then involve weighing the potential benefits against the risks of intervention, always guided by established clinical guidelines and ethical principles. When faced with uncertainty, prioritizing further investigation and consultation over immediate, potentially premature, action is crucial.

Scenario Analysis: This scenario presents a professional challenge due to the inherent complexity of managing a patient with a rare, aggressive malignancy requiring a multidisciplinary approach. The challenge lies in balancing the urgency of surgical intervention with the need for comprehensive pre-operative assessment, patient consent, and ethical considerations regarding experimental treatments. Careful judgment is required to navigate potential conflicts between established protocols, emerging research, and the patient’s individual circumstances and preferences. Correct Approach Analysis: The best professional practice involves a thorough, multi-stage process. Initially, a comprehensive diagnostic workup and staging are essential to fully understand the extent of the disease and its impact on surrounding structures. This is followed by a detailed discussion with the patient and their family, outlining all available treatment options, including the risks, benefits, and uncertainties associated with each. Crucially, this discussion must include the rationale for considering an investigational approach, emphasizing that it is not a standard of care and requires specific ethical and regulatory approvals. Obtaining fully informed consent, documented meticulously, is paramount. Subsequently, a multidisciplinary team meeting should convene to finalize the treatment plan, ensuring all specialists agree on the proposed surgical strategy and any adjuvant or neoadjuvant therapies. This approach prioritizes patient autonomy, safety, and adherence to ethical guidelines for novel treatments. Incorrect Approaches Analysis: Proceeding directly to surgery without a complete diagnostic workup and detailed discussion of all options, including the investigational nature of the proposed therapy, fails to uphold the principle of informed consent and patient autonomy. It risks performing an unnecessary or suboptimal procedure and exposes the patient to risks without their full understanding. Initiating the investigational treatment without obtaining the necessary ethical review board (IRB) or equivalent institutional approval and without ensuring the patient fully comprehends the experimental nature and associated risks is a significant ethical and regulatory violation. This bypasses critical safeguards designed to protect vulnerable patients. Delaying surgery indefinitely to await further research or more definitive evidence, without adequately discussing the potential for disease progression and the risks of inaction with the patient, can be detrimental. While caution is warranted, a balanced approach that considers the patient’s prognosis and preferences is necessary. Professional Reasoning: Professionals should employ a structured decision-making framework that begins with a thorough assessment of the clinical situation. This is followed by open and honest communication with the patient and their family, ensuring they are empowered to make informed decisions. Ethical principles, including beneficence, non-maleficence, autonomy, and justice, must guide every step. Adherence to institutional policies and relevant regulatory guidelines for experimental treatments is non-negotiable. When faced with novel or complex cases, collaboration within a multidisciplinary team is essential to achieve the best possible outcome while upholding the highest standards of care.