Complex surgical procedures carry signifcant risks and potential for complications, whether performed alone (as single procedure) or in combination (as multiple surgical procedures). Despite the most conscientious preoperative preparations, surprising events may still occur. If the operation takes an unplanned turn, the surgeon has to make diffcult decisions. Some of the most important elements of any surgical procedure are the decisions that the surgeon makes before, during, and after the surgery itself. Notewithstanding its enormous signifcance and regardless of the implications that this decision-making process (DMP) has on surgical outcomes, the subject has received minimal attention in the literature . Subsequently, there are only a few studies that investigate how these decisions are made, although DMP is of great importance both for training and patient safety purposes. How do we surgeons make intraoperative decisions under what can be inauspicious conditions? Some describe these decisions as “intuition” or “gut-level” responses. However often we surgeons have diffculty in describing exactly how we came to specifc decisions during surgery. Clearly, there are many factors that affect decisionmaking of surgeons before and during operations. These factors are the physiologic state of the surgeon, the harmony of teamwork, external factors at work, and the surgeon’s ability to adapt quickly to a changing environment, to name only a few. Yet, the question remains, how to perform an evaluation of the surgical decision and gaining a better understanding of a seemingly gut- level process, which helps surgeons combat the external factors experienced before and during surgery?