I went for clarity of detail, with the subject's skin texture, the reflective properties of the surgical instrument, and the faintest details visible on the metric scale of the instrument. The shallow depth of field draws attention to the central subject, while the background characters are out of focus (mimicking the way human eyes perceive depth with this kind of backlighting). The lighting is consistent with a real surgical environment, with high-contrast areas and sharp, focused shadows that provide a sense of dimensionality. There's realistic texture to the gloves and garments. I wanted it to look both artistic and realistic, so went for subdued and sterile color as you'd expect in a surgical envirionment, but lifted the color very slightly for aesthetics.