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Correspondence |

Reminder of the Metrics of Endosurgical Innovation

Brij B. Agarwal, MBBS, MS, Dip Yoga, FIMSA; Chintamani Chintamani, MS, FRCS(Edin),  FRCS(Glasg), FACS, FICS, FIMSA
Arch Surg. 2011;146(9):1108. doi:10.1001/archsurg.2011.199.
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Congratulations to Curet1 for putting the horse (innovations) back in front of the cart (clinical outcomes) for the journey of a new generation of surgeons obsessed with a desire to be different,2 forgetting the maxim primum non nocere. Laparoscopic cholecystectomy, the index endosurgery, continues to be haunted by the adverse outcome of bile duct injury, which is an index metric for assessing endosurgical innovations. Contemporary scientific discourse on endosurgical innovations aims to make bile duct injury a “never event,” underscoring the quest for zero tolerance for any compromise-prone innovation.3 However, even after 2 decades of proficiency, the rates of bile duct injury remain higher than expected despite continuous improvement in technology and innovations. Conventional surgery is also single incision; single-incision laparoscopic surgery (SILS) just camouflages the site of incision.

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