LAUSR

T he traditional model for surgical research typically involves generating incremental improvements in clinical outcomes either through the optimization of existing approaches, or through the introduction of novel techniques. This process is often painstakingly slow with a significant time lag from the initial development of an idea, through to the delivery of a highly controlled trial and subsequent clinical translation. In many instances, this resource consuming process may not produce an agreed conclusion nor be widely adopted within routine practice. Surgical research is absolutely necessary during a pandemic to guide surgical treatment during the pandemic, to prepare surgical services for what is to come after the pandemic, and the next stages of healthcare recovery. The current COVID-19 pandemic has demonstrated that the existing paradigm of surgical research, predominantly reliant upon incremental innovation, is not fit for this purpose. As such, to prevent avoidable harm, we must now urgently adapt from a rigid system of highly controlled prospective trials, towards an adaptive and pragmatic approach, which is focused upon delivering agile evidencebased changes in practice at pace and scale. To achieve this, we must be cognizant of the specific challenges that lie ahead and the strategies that we must champion so that we may overcome them.