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This article is the authors' final version prior to publication in Langenbeck's Archives of Surgery, Volume 408, Issue 1, January 2023, Article number 42.

The published version is available at Copyright © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.


Surgeons during their career will likely be called in to assist or offer advice with an unanticipated intraoperative event or finding. Yet, there is no practical framework of how to respond to these consults nor is there any formal training in this area.

Review of the limited literature and expert senior opinion can help explain the ethical components involved but do not address some of the practical aspects that the consulting surgeon may need to confront when responding to an unplanned intraoperative consultation.

In this manuscript we present a selected review of the available literature on the topic, establish some of the guiding ethical principles and offer an actionable and detailed framework that can support trainees and practicing surgeons dealing with these increasingly common and stressful unplanned circumstances.

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