Assessing Surgical Innovation

At the heart of the study is the IDEAL framework (Idea; Development; Exploration; Assessment; Long-term study) a five-stage model developed at the University of Oxford to guide the evaluation of new surgical procedures—from initial concept, through development and exploratory use, to formal assessment and long-term follow-up in routine practice. By insisting on stepwise testing, transparent reporting and robust clinical data, IDEAL aims to ensure that innovation goes hand in hand with patient safety and scientific quality. 

The ALPPS procedure (Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy), developed in Zurich, is presented as a flagship example of this structured pathway. Initially associated with high complication rates, ALPPS was systematically refined through an international registry, a consensus conference defining indications and technical standards, a randomised controlled trial against conventional surgery, and a benchmarking project that set global quality targets. This combination of tools led to a marked reduction in mortality and transformed ALPPS into a safe option for patients with extensive liver tumours previously deemed inoperable. 

Beyond ALPPS, the authors argue that the future of surgical progress—whether in minimally invasive or robotic approaches—depends on global collaboration, shared data platforms and standardised evaluation methods. The IDEAL model is proposed not as a rigid protocol, but as a practical guide for responsibly translating surgical innovation from the operating theatre to everyday clinical care, ensuring that new techniques benefit patients while maintaining rigorous scientific standards.

Publication:

Linecker M, Pfister M, Kambakamba P, Lang H, de Santibañes E, Barkun J, Clavien PA. Assessing Surgical Innovation: ALPPS: An IDEAL Example of Disruptive Innovation. Ann Surg. 2025; 282(5): 678-689.