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Never ever perform any surgical procedure without patient's or carer's consent. Always spend some time discussing with the patient or carer about the possible complications of a particular procedure and discuss that there may arise a situation during the surgery to do extra procedures, including removal of adjacent structures, in the long term interest of the patient. All of this must be documented as it is far better to spend some time with the patient or carer before getting consent than having to suffer the torture of facing GMC or even the Police. That can surely be the worst nightmare of any surgeon's career.