Since the establishment of the abdominal surgery

as an independent eld, every operation will be performed according to the certain technical stan­dards. ese standards have been appropriately adapted for the new knowledge and technical developments. However deals a practical surgeon frequently with situations, in these originally simi­lar operations can have very dierent develop­ment. A lot of predisposing factors can inuence it: dierent anatomy and morphology of operational areas, dierent eects of the similar intraoperative steps (bleeding aer tissue transection, organs injured during the abdominal opening), surgical experience, manual skill, drop out of instruments and devices, strategic problems, mental condition from every team member, as well as a quality of assistance. All these factors can make the perfor­mance of every operation dicult, especially in cases when a surgeon is “programmed” to achieve certain technical standards. Until today, there is no denition of what constitutes a dicult surgical situation, but every practical surgeon knows very well what it means and how important it is. We dene the dicult surgical situation as an intraop­erative surgical problem, which increases the like­lihood of intraoperative and postoperative complications, if the initially planned surgical pro­cedure was carried out without modications. In a dicult surgical situation, the surgeon gets into dilemma whether to continue the intended opera­tion “at all costs” or to deviate from the initially planned surgical procedure to some alternative technique. Choosing the rst option can increase the risk of intra- and postoperative complications. For example, performance of a complete instead of “subtotal” cholecystectomy by severe brotic changes in Calot’s triangle can lead to bile duct injury. Enforcement of hemithyroidectomy in case of the dicult surgical anatomy can have a recur­rent lesion as a result. ere are further examples on this subject. e consequence of the second alternative might be a lower risk of short- term complications but at the expense of worse results in the long term. In oncologic surgery, for exam­ple, earlier recurrences due to R1 resection status or unsatisfactory functional results represent typi­cal problems. When making the decision to oper­ate or not, but also when selecting the best surgical technique, it would be important to know a patient’s individual risk of intraoperative dicul­ties. From a surgeon’s perspective, intraoperative diculties are therefore more than just a surrogate