title: Trials in surgery.
abstract: BACKGROUND
  Trials in surgery pose some special problems. This paper examines these with reference to 10 years of methodological research sponsored by the UK National Health Service Research and Development programme.
  
  
  METHODS
  Solutions to common problems encountered in surgical studies were considered, such as issues of blinding, dependence of results on technical skill and continued evolution of technology.
  
  
  RESULTS
  Numerous methodological developments are described, including the tracker trial concept in which trial design can be adapted to take account of technical developments and interim results. The governance of trials, solutions to ethical conundra and the rising importance of databases are also discussed.
  
  
  CONCLUSIONS
  Like surgery itself, the methodological toolkit for evaluation of surgical procedures continues to evolve. The rules of statistical and scientific probity provide plenty of scope for imaginative design solutions for surgical trials.
authors.affiliation: Department of Public Health and Epidemiology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. r.j.lilford@bham.ac.uk
authors.forename: R
authors.initials: R
authors.lastname: Lilford
authors.forename: D
authors.initials: D
authors.lastname: Braunholtz
authors.forename: J
authors.initials: J
authors.lastname: Harris
authors.forename: T
authors.initials: T
authors.lastname: Gill
mesh_terms: D015982:Bias; D004992:Ethics, Medical; D019317:Evidence-Based Medicine; D006801:Humans; D017060:Patient Satisfaction; D018579:Patient Selection; D016032:Randomized Controlled Trials as Topic / Q000941:ethics / Q000379:methods*; D018401:Sample Size; D012680:Sensitivity and Specificity; D013514:Surgical Procedures, Operative / Q000941:ethics / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome