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Br J Surg. 2016 Apr;103(5):607-15. doi: 10.1002/bjs.10115. Epub 2016 Feb 10.

Practical guide to the Idea, Development and Exploration stages of the IDEAL Framework and Recommendations.

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Department of Surgery, Maimonides Medical Center, Brooklyn, New York, USA.
IDEAL Collaboration, Nuffield Department of Surgical Science, Oxford, UK.
Interventional Procedures and Medical Technologies Advisory Committees, National Institute for Health and Care Excellence, London, UK.
Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA.
Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Department of Surgery, Division of Hepatobiliary and Transplant Surgery, McGill University Health Centre, Royal Victoria Hospital. Montreal, Quebec, Canada.



Evaluation of new surgical procedures is a complex process challenged by evolution of technique, operator learning curves, the possibility of variable procedural quality, and strong treatment preferences among patients and clinicians. Preliminary studies that address these issues are needed to prepare for a successful randomized trial. The IDEAL (Idea, Development, Exploration, Assessment and Long-term follow-up) Framework and Recommendations provide an integrated step-by-step evaluation pathway that can help investigators achieve this.


A practical guide was developed for investigators evaluating new surgical interventions in the earlier phases before a randomized trial (corresponding to stages 1, 2a and 2b of the IDEAL Framework). The examples and practical tips included were chosen and agreed upon by consensus among authors with experience either in designing and conducting IDEAL format studies, or in helping others to design such studies. They address the most common challenges encountered by authors attempting to follow the IDEAL Recommendations.


A decision aid has been created to help identify the IDEAL stage of an innovation from literature reports, with advice on how to design and report the IDEAL study formats discussed, along with the ethical and scientific rationale for specific recommendations.


The guide helps readers and researchers to understand and implement the IDEAL Framework and Recommendations to improve the quality of evidence supporting surgical innovation.

[Indexed for MEDLINE]

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