How can we improve surgical research and innovation?: The IDEAL framework for action

Hirst, Allison; Agha, Riaz; Rosin, David; McCulloch, Peter

doi:10.1016/j.ijsu.2013.09.016

Cited by 47 publications

(26 citation statements)

References 29 publications

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“…Clinical evidence must be appreciated in the context of respective chronological stages that occur within a typical evolution cycle of surgical innovation. A generic framework outlining these stages has been developed through the IDEAL Collaboration (Idea, Development, Exploration, Assessment, and Long‐term follow‐up) . There is an inherent risk of bias in undertaking high level of evidence studies that compare established technique(s) with new alternatives.…”

Section: Discussionmentioning

confidence: 99%

“…It remains largely unclear how the many technological enhancements offered by robot‐assistance might translate into clinically measurable outcome benefits. As RAP becomes more established, this application of robotic surgery will inevitably transition towards an era of critical assessment . Accordingly, comparative studies are increasingly emerging and this allows opportunities for quantitative data synthesis to more definitively evaluate effectiveness of RAP against established best‐practice techniques.…”

Section: Introductionmentioning

confidence: 99%

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Meta‐analysis of robot‐assisted vs conventional laparoscopic and open pyeloplasty in children

et al. 2014

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ObjectiveTo critically analyse outcomes for robot-assisted pyeloplasty (RAP) vs conventional laparoscopic pyeloplasty (LP) or open pyeloplasty (OP) by systematic review and meta-analysis of published data. Patients and MethodsStudies published up to December 2013 were identified from multiple literature databases. Only comparative studies investigating RAP vs LP or OP in children were included. Meta-analysis was performed using random-effects modelling. Heterogeneity, subgroup analysis, and quality scoring were assessed. Effect sizes were estimated by pooled odds ratios and weighted mean differences. Primary outcomes investigated were operative success, re-operation, conversions, postoperative complications, and urinary leakage. Secondary outcome measures were estimated blood loss (EBL), length of hospital stay (LOS), operating time (OT), analgesia requirement, and cost. ResultsIn all, 12 observational studies met inclusion criteria, reporting outcomes of 384 RAP, 131 LP, and 164 OP procedures. No randomised controlled trials were identified. Pooled analyses determined no significant differences between RAP and LP or OP for all primary outcomes. Significant differences in favour of RAP were found for LOS (vs LP and OP). Borderline significant differences in favour of RAP were found for EBL (vs OP). OT was significantly longer for RAP vs OP. Limited evidence indicates lower opiate analgesia requirement for RAP (vs LP and OP), higher total costs for RAP vs OP, and comparable costs for RAP vs LP. ConclusionsExisting evidence shows largely comparable outcomes amongst surgical techniques available to treat pelvi-ureteric junction obstruction in children. RAP may offer shortened LOS, lower analgesia requirement (vs LP and OP), and lower EBL (vs OP); but compared with OP, these gains are at the expense of higher cost and longer OT. Higher quality evidence from prospective observational studies and clinical trials is required, as well as further cost-effectiveness analyses. Not all perceived benefits of RAP are easily amenable to quantitative assessment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Meta‐analysis of robot‐assisted vs conventional laparoscopic and open pyeloplasty in children

et al. 2014

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“…Next, in the development phase, when the procedure is tested in a small group of patients to assess its efficacy, prior ethical approval must be given. [6,7] …”

Section: Resultsmentioning

confidence: 99%

“…[7–9,11,12,21,22,24,26,34,37,39,44,53] Most authors agree that some form of training for surgeons performing novel procedures is necessary. Examples of how to deal with the surgeon's learning curve include hands-on training (in animal models or human cadavers), [8,24,26,39] visiting different surgeons who are performing the procedure, [12,22] and the presence of a mentor or even a committee.…”

Section: Resultsmentioning

confidence: 99%