Research in surgery: The adversities that every surgeon should know and face

Abstract

• Despite a rich history of surgeon-researchers, there is a perception that basic science and clinical research has lose relevance in surgery lately. • Conducting an RCT in surgery is methodologically challenging and other sources of evidence may suit better in some cases. • The learning curve effect must be took into account when reporting results. • Placebo and blinding are not always possible nor ethical in surgical research. • The dual-role of surgeon and researcher makes for the patient hard to distinguish between clinical practice and research methods. Clinical and experimental research in medicine has been the main path to most of advances in diagnosis and therapy throughout the history, with remarkable surgeons as researchers. To develop good quality research in surgery is a challenge since special issues difficult the process and lack of time and resources discourage residents and surgeons from conducting research. The aim of this narrative review is to explore the barriers for the surgeon-researcher. The challenges to investigate in surgery arise from many aspects of research itself. There are methodological difficulties for developing good quality evidence, since randomizing, blinding and placebo interventions are difficult to apply in surgical trials. Furthermore, the learning curve effect makes outcomes hard to interpret. From the researcher point of view, time and resources are scarce and no priority seems to be given to research in surgery residencies and during daily practice. Regarding the ethical point of view, the surgeon researcher must face conflictive issues as the patient´s "therapeutic misconception", the debatable use of placebo in surgical trials and animal experimentation, along with other bioethical issues. There are both external and inherent difficulties in researching in surgery. A long way is yet to be followed until our surgical conducts are fully evidence based. Under these circumstances, surgery may remain being an art, but as surgeons we have to look forward to converting surgery in an evidence-based art.