How do I balance the need to follow established protocols and guidelines with the need to be flexible and adapt to changing circumstances during surgery?

It’s really important to pay attention throughout the case as an issue can arise any time and we should anticipate the doctors needs.
Of course policies are important to follow but we also need to use critical thinking which you learn with experience. Hope this is helpful.

Like every situation, there are protocols and standards to guide you. However, there are instances that don't fit nicely into a nice neat example. Evaluate each situtation and make the best judgement based on what is happening.