Surgical research or comic opera? Let’s give answers!

In 1996, the editor of the Lancet could only recognize comical aspects of surgical research [1]. Following his provocative headline, Horton stated that surgeons do have questions but few answers, as only 7% of all surgical articles report results of randomized controlled trials (RCT), whereas 46% describe case series with a low grade of evidence. Providing well-designed, high-quality studies and evaluating the results is an indispensable task for the surgical community in order to improve patient care. In surgery, the wish for well-explored or widely accepted techniques often opposes the need to strike a new path. Noone would doubt that, to make progress and bring forward new ideas, we need capable and courageous surgeons. The European Association for Endoscopic Surgery (EAES) as a scientific society should take a leading role in the development and evaluation of endoscopic surgery. With its evidence-based guidelines on surgical procedures and techniques, the EAES has taken up its responsibility to support surgeons with well-founded recommendations in several fields of endoscopic surgery [2]. However, during the development of those guidelines it again became apparent that there is still a lack of high-quality evidence for several topics of endoscopic surgery, and that highquality clinical trials are urgently needed.With the intention to find research questions with major impact on clinical care, Urbach et al. [3] developed a research agenda and identified 33 topics in gastrointestinal and endoscopic surgery. They selected the 40 most important research questions in our field and suggested that this agenda may be used by researchers and researchgranting agencies to focus research activities and to appraise the relevance of scientific contributions. Although this agenda has been developed by members of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), the lack of research evidence is clearly a global problem.