Homogeneity in Surgical Series: Image Reporting to Improve Evidence

Good clinical practice guidelines are based on randomized controlled trials or clinical series; however, technical performance bias among surgical trials is under-assessed. The heterogeneity of technical performance within different treatment groups diminishes the level of evidence. Surgeon variability with different levels of experience—technical performance levels even after certification—influences surgical outcomes, especially in complex procedures. Technical performance quality correlates with the outcomes and costs and should be measured by image or video-photographic documentation of the surgeon’s view field during the procedures. Such consecutive, completely documented, unedited observational data—in the form of intra-operative images and a complete set of eventual radiological images—improve the surgical series’ homogeneity. Thereby, they might reflect reality and contribute towards making necessary changes for evidence-based surgery.