Postponement of IDEAL 2020 Conference in Amsterdam due to COVID-19

Due to the COVID-19 pandemic we have taken the difficult decision to postpone our international IDEAL 2020 Conference scheduled to take place on 11th-12th June 2020 in Amsterdam. We now anticipate holding the event in April 2021 in Amsterdam. Please bear with us as the Organising Committee works through the next steps and confirms the new date.

We will be sending further communications to individuals with accepted abstracts as soon as possible and more information will be posted on our websites about the future event as it becomes available: and

Thank you all for your understanding in these uncertain times, and we wish you all the best.

We will endeavour to host a successful and enjoyable IDEAL 2021 Conference in Amsterdam in the spring.

Maroeska Rovers and Peter McCulloch, On behalf of the Organising Committee

How should innovation be evaluated in global surgery? Contribute your thoughts. Survey is now open.

Invitation on behalf of the Global Health Research Group in Surgical Technologies

Are you a surgeon or surgical researcher with an interest in global surgery, surgical innovation or technology? Or perhaps you have or want experience in evaluating surgical technology and/or innovations in global surgery?

Can you spare just 20 minutes to complete our survey? This study aims to develop a framework for the evaluation of innovation in global surgery. The survey explores barriers and facilitators to evaluating innovation and technology in global surgery. In particular, how should we evaluate the adoption of an established technology in a novel context or setting?

If so please click the link here

We are a group of researchers from the University of Leeds called the Global Health Research Group in Surgical Technologies ( The primary aim of the group is to develop and evaluate novel technologies to improve surgical training and care in LMICs.

All the questions are in English. You do not have to complete the survey and your participation is entirely voluntary. You will not be asked for your name or email address as part of the survey itself, however once you complete the survey you will have the opportunity to express your interest to be involved in a semi-structured interview about your experiences with a member of the research team. This may be conducted online.

More information can be found on the opening page of the survey in the participant information page before you begin the survey. To view this, just click the survey link above.

If you have any questions about this study please email Dr William Bolton at the University of Leeds, 

This study has received ethical approval from the University of Leeds School of Medicine Research Ethics Committee MREC 18-102.

Thank you for your time,

Dr William Bolton on behalf of the NIHR Global Health Research Group in Surgical Technologies

NIHR Clinical Research Fellow
Global Surgical Technologies
Co-Founder MedTechFoundation


IDEAL Conference 2020 – Amsterdam 11-12th June

IDEAL2020 in Amsterdam, the Netherlands: Innovation and Evaluation in Surgery

Save the date: 11th-12th June 2020

IDEAL2020 will bring together clinicians and researchers from all over the world to discuss the latest scientific methodological developments on investigating new surgical interventions and medical devices in a variety of clinical areas.

The programme will include state-of-the-art plenary lectures, workshops, sandpit session and selected presentations from submitted abstracts. There will be ample opportunity for interactive discussions and networking.

The deadline for abstract submission is 1st February 2020, and the early bird registration deadline is 22nd March 2020. Please visit this link to submit your abstract and/or to register for the conference:

The congress venue is located at one of the famous Amsterdam canals, and can be reached very easy by tram from the central station. It is just a short walk from Amsterdam’s leading cultural centre.

For more information please keep an eye on our twitter accounts:



New Journal: BMJ Surgery, Interventions, & Health Technologies

BMJ Surgery, Interventions, & Health Technologies

BMJ Surgery, Interventions, & Health Technologies is an open access journal that publishes original research on complex healthcare interventions. Intended to encourage higher standards of science and more rapid dissemination of new knowledge in the field, it provides a high-impact international platform for both early and later stage clinical studies as well as long-term assessment and surveillance studies that meet high standards of design and reporting. It actively promotes the adoption of an IDEAL-based model of an evaluation framework and encourages the submission of studies at progressive stages, with a focus on device-based surgical and invasive treatments.

Read the Editorial: Lighting a candle by Art Sedrakyan and Peter McCulloch

There has been enough cursing of the darkness engendered by inadequate evaluation of new health technology and surgical and interventional treatments. We can do better.

To submit an article read the Instructions for authors and follow the link to the manuscript submission site.

IDEAL features in the February 2019 Issue of Annals of Surgery


The Current Issue of the Annals of Surgery features four papers about IDEAL

February 2019Volume 269Issue 2 



This editorial calls for reporting checklists for the IDEAL Stages which will enable researchers and journals to publish better reports of surgical innovation. We are pleased to announce that such reporting guidelines are now in development by the IDEAL team (Nicole Bilbro, Allison Hirst, Tom Lewis, Riaz Agha and Peter McCulloch) – the published protocol for the Delphi consensus development process is available here:

The Update to the IDEAL Framework and Recommendations:

This paper incorporates additional relevant methodological principles that have developed in the surgical community since the original IDEAL papers in 2009.

No Surgical Innovation Without Evaluation: Evolution and Further Development of the IDEAL Framework and Recommendations

Hirst, Allison; Philippou, Yiannis; Blazeby, Jane; Campbell, Bruce; Campbell, Marion; Feinberg, Joshua; Rovers, Maroeska; Blencowe, Natalie; Pennell, Christopher; Quinn, Tom; Rogers, Wendy; Cook, Jonathan; Kolias, Angelos G; Agha, Riaz; Dahm, Philipp; Sedrakyan, Art; McCulloch, Peter.

A perspective on the ethical concepts to be considered at each IDEAL stage of innovation of a new technique or device:

An example of the evolving learning curves in laparoscopic liver surgery according to descriptions of surgeons in stages 2 and 3 of IDEAL:

A Comparison of the Learning Curves of Laparoscopic Liver Surgeons in Differing Stages of the IDEAL Paradigm of Surgical Innovation: Standing on the Shoulders of Pioneers

Halls, Mark Christopher; Alseidi, Adnan; Berardi, Giammauro; Cipriani, Federica; Van der Poel, Marcel; Davila, Diego; Ciria, Ruben; Besselink, Marc; D’Hondt, Mathieu; Dagher, Ibrahim; Alrdrighetti, Luca; Troisi, Roberto Ivan; Abu Hilal, Mohammad

Annals of Surgery: February 2019 – Volume 269 – Issue 2 – p 221–228

Announcing a new Journal: BMJ Surgery, Innovation and Health Technology

Announcing a new BMJ Journal 

We are delighted to announce that Prof Peter McCulloch (Chair of the IDEAL Collaboration) (below left) and Prof Art Sedrakyan (Vice-Chair) (below right) have been invited to become joint Editors in Chief of a new journal in the BMJ stable.  The journal will be called BMJ Surgery, Innovation and Health Technology, and we expect to produce the first issue early in 2019.

Scope of the Journal: The focus will be on evaluation of innovation in surgery, other invasive therapeutic techniques (such as interventional radiology, endoscopy, cardiology etc) and therapeutic medical devices. The Journal will be serving both surgical and technology communities (IDEAL and MDEpiNet community/societies). We will concentrate to a significant extent on early stage evaluation, and on registry-based studies, but will consider work at all stages in the life cycle of a therapy, from first-in-human use to long term study.  We will welcome studies in the formats prescribed by the IDEAL and IDEAL-D Recommendations, and our Instructions for Authors will include clear guidance on how to report such studies.  We intend to have a significant section dealing with reports from regulatory surveillance systems, registries and epidemiological studies using real world data and specific guidance will be available for any unique article types.

Our aim is to develop a thriving Journal which provides a platform for valid, appropriate studies of new complex therapeutic interventions using designs and reporting methods which allow maximum transparency.  To achieve this we will seek to ensure that the Impact Factor of the journal, which will be calculated after two years of publication, is high enough to ensure that it becomes the journal of choice for the type of studies we will specialise in.  We are therefore especially keen to hear from any Collaboration members who have unpublished work which they believe is liable to be newsworthy and/or strongly cited, and would urge you to submit to the new journal.  In the first two years of the journal we intend to experiment with our Editorial policy over formats and may be willing to discuss Supplements and compendium articles as well as reviews on highly topical issues.  An Editorial platform is currently under construction, and  an initial Editorial panel of referees has been appointed.  We will post a further announcement when the journal goes live for formal submissions, but would be glad to hear from you now if you would like to discuss possible submissions informally or volunteer to be a peer reviewer.

Peter McCulloch and Art Sedrakyan,

On Behalf of the IDEAL Collaboration and MDEpiNet






New IDEAL paper: Evolution and Further Development of the IDEAL Framework and Recommendations

Hirst A, Philippou Y, Blazeby J, Campbell B, Campbell M, Feinberg J, Rovers M,  Blencowe N, Pennell C, Quinn T, Rogers W, Cook J, Kolias AG, Agha R, Dahm P, Sedrakyan A, McCulloch P. No Surgical Innovation Without Evaluation: Evolution  and Further Development of the IDEAL Framework and Recommendations.  Ann Surg.  2018 Apr 24. doi: 10.1097/SLA.0000000000002794. [Epub ahead of print] PubMed  PMID: 29697448.

A writing group from the IDEAL Collaboration including surgeons, research trialists, methodologists, statisticians, ethicists, and experts in device evaluation and HTA have developed an update to the original IDEAL Framework papers published in the Lancet in 2009.


OBJECTIVE: To update, clarify, and extend IDEAL concepts and recommendations.

BACKGROUND: New surgical procedures, devices, and other complex interventions need robust evaluation for safety, efficacy, and effectiveness. Unlike new medicines, there is no internationally agreed evaluation pathway for generating and analyzing data throughout the life cycle of surgical innovations. The IDEAL Framework and  Recommendations were designed to provide this pathway and they have been used increasingly since their introduction in 2009. Based on a Delphi survey, expert workshop and major discussions during IDEAL conferences held in Oxford (2016) and New York (2017), this article updates and extends the IDEAL Recommendations, identifies areas for future research, and discusses the ethical problems faced by investigators at each IDEAL stage.

METHODS: The IDEAL Framework describes 5 stages of evolution for new surgical therapeutic interventions-Idea, Development, Exploration, Assessment, and Long-term Study. This comprehensive update proposes several modifications.

  1. A “Pre-IDEAL” stage describing preclinical studies has been added.
  2. We discuss potential adaptations to expand the scope of IDEAL (originally designed for surgical procedures) to accommodate therapeutic devices, through an IDEAL-D variant.
  3. We explicitly recognise the value of comprehensive data collection through registries at all stages in the Framework.
  4. We examine the ethical issues that arise at each stage of IDEAL and underpin the recommendations.

The Recommendations for each stage are reviewed, clarified and additional detail added. We use a PICO format to outline the key features of each stage, outline reporting guidance for each stage and describe how to identify when an endpoint to a stage has been reached.

CONCLUSIONS: The intention of this article is to widen the practical use of IDEAL by clarifying the rationale for and practical details of the Recommendations. Additional research based on the experience of implementing these Recommendations is needed to further improve them.

We look forward to developing these Recommendations further by working with surgical researchers developing innovative surgical therapies and medical devices.


Progress in clinical research in surgery and IDEAL

Peter McCulloch, Chair of IDEAL and co-authors examined progress in surgical research and their findings are now published in The Lancet Online First

Joshua Feinberg, surgeon, researcher and member of the IDEAL Collaboration at Maimonides Medical Center, Brooklyn, New York describes the research undertaken to examine how surgical research has improved in the last two decades and whether the IDEAL Framework and Recommendations have contributed.

“The quality of clinical research in surgery has long attracted criticism. High-quality randomised trials have proved difficult to undertake in surgery, and many surgical treatments have therefore been adopted without adequate supporting evidence of efficacy and safety. To address this, we conducted a review of the progress of methodology in clinical studies of surgery, and whether it is moving towards compliance with the IDEAL Recommendations.

To evaluate progress, we examined the surgical literature, focusing specifically on studies of surgical outcomes, in two periods 10 years apart, one before and one after the publications of the IDEAL Recommendations (2000-2004 and 2010-2014). Compliance with the following IDEAL recommendations were compared between the two time periods:

  • Use of standardised terminology
  • Definition and description of procedure
  • Prospective data collection
  • Explanation of modifications during early studies (2a)
  • Previous analysis of learning curves in pre-RCT studies
  • Use of quality control measures
  • Use of qualitative research to define RCT questions
  • Use of prior prospective cohort study to prepare for RCTs
  • Mention of pilot of feasibility studies to prepare for RCT
  • Masking reported in RCTs

The main findings of the study include:

IMPROVEMENT in the use of standard outcome measures, adoption of Consolidated Standards of Reporting Trials (CONSORT) standards, and assessment of the quality of surgery and of learning curves.

NO PROGRESS in the use of qualitative research or reporting of modifications during procedure development.

When discussing visions for the future, the paper concludes

“Surgical research is getting better, although it still has a long way to go…The IDEAL Framework and Recommendations have probably only contributed in a minor way to the improvements seen so far, but their influence is growing, they are useful as a tool to measure progress, and they represent a serious attempt to create a new framework for surgical research methodology.”


China IDEAL Centre now open in Chengdu, China

We are pleased to announce that the China IDEAL Centre was opened in Chengdu, Schizuan province, on 28th October 2017.

The Director, Professor Xin Sun, is also Director of the Chinese Cochrane Centre, and of a large statistics and clinical epidemiology department at the West China Hospital in Chengdu. Funded by the Chinese government through the West China hospital and university, the centre will educate clinicians about IDEAL and research methodology and help groups to develop their clinical research using IDEAL principles.

At the opening event of the Centre Professor Xin Sun and the Emeritus Director, Professor Louping Yi, emphasised the value of IDEAL for the evaluation of new medical devices and procedures in the Chinese health system.  They referred to recent new guidance from the FDA on the use of “real world evidence” to evaluate devices, and stressed how IDEAL could provide a guiding template for interpreting FDA proposals.  This theme was supported by the representative of the Chinese FDA who spoke at the meeting, who explained how China aimed to develop a distinctive approach which is nevertheless compatible with US FDA guidance.

Professor Peter McCulloch (IDEAL Chair) presented two talks, one on the principles of IDEAL and the other on its use in device evaluation, and how it could assist regulators and healthcare purchasers.

The meeting was generously sponsored by Medtronic China, whose Vice-President for Clinical Affairs, Xioajing Chen, made a presentation on Medtronic’s plans for device surveillance.

We look forward to supporting and collaborating with IDEAL China. Future plans include development of a post-doctoral Fellowship in Oxford for one of the IDEAL China staff and co-operation on research projects. It was agreed that one important area where IDEAL needed to develop a clear position was the guidelines for policy on what types of evidence should be acceptable for regulation or purchasing in which stages of evolution of a device.  An annual IDEAL China conference is planned and it is hoped next year’s event will be able to report progress based on this year’s meeting.