Many surgical revolutions distinguish the history and evolution of surgery. Some are small, others more dominant, but each revolution improves the art and science of surgery. Surgical revolutionaries are indispensable in the conception and completion of any surgical revolution, initiating scientific and technological advances that propel surgical practice forward. Surgical revolutionaries can come in the guises of Lister (antisepsis), Halsted (surgical residency and safe surgery), Cushing (safe brain surgery), Wangensteen (gastrointestinal physiological surgery), Blalock (relief of cyanotic heart disease), Lillehei (open heart surgery), and many others. With the hindsight of history, we can recognize patterns of progress, evaluate means of advancing new ideas, and solidify details of innovative behavior that could lead to new surgical revolutions. This volume examines the following vital questions in detail: What is a surgical revolution and how do we recognize one? Are surgical revolutionaries different? Is there a way to educate new surgical revolutionaries? Can history provide enduring examples of surgical revolutions? Are there different kinds of surgical revolutions? What characterizes a surgical revolution in the context of science and technology? What surgical revolutions are on the horizon?

In December, 1966, two patients dying of months after the transplants had been per uremia as a result of diabetic kidney disease formed. This was long enough, however, to were offered a small chance of survival. Ac establish unequivocally in both patients cording to the thinking of the time, it was that an endocrine organ, the pancreas, could inappropriate-and perhaps even unethical function normally and for many days as a to offer them either chronic hemodialysis or human-to-human graft. The patients had kidney transplantation. These were considered become normoglycemic independent of insulin a waste of effort because it was believed that injections. scarce medical resources should not be spent The possible long-term benefits of restoring on patients, uremic or not, whose chances of insulin function were hotly argued then, and surviving for more than a few months were they have not been fully determined 20 years thought to be very small. Reduced to its later. It seems to me now, however, that the essence, the idea was that diabetic patients basic premise is sounder than I realized in were terrible risks and would remain so even if 1966: if one could restore an effective, norm the uremia were corrected."

In December, 1966, two patients dying of months after the transplants had been per uremia as a result of diabetic kidney disease formed. This was long enough, however, to were offered a small chance of survival. Ac establish unequivocally in both patients cording to the thinking of the time, it was that an endocrine organ, the pancreas, could inappropriate-and perhaps even unethical function normally and for many days as a to offer them either chronic hemodialysis or human-to-human graft. The patients had kidney transplantation. These were considered become normoglycemic independent of insulin a waste of effort because it was believed that injections. scarce medical resources should not be spent The possible long-term benefits of restoring on patients, uremic or not, whose chances of insulin function were hotly argued then, and surviving for more than a few months were they have not been fully determined 20 years thought to be very small. Reduced to its later. It seems to me now, however, that the essence, the idea was that diabetic patients basic premise is sounder than I realized in were terrible risks and would remain so even if 1966: if one could restore an effective, norm the uremia were corrected."

Interest in surgical research was a decisive factor in the surgical advances seen in the 20th century. From the "stormy petrel" of surgery (John B. Murphy) to the pioneering Mayo brothers and the gifted surgeons who revolutionised cardiac surgery (Drs Blalock, DeBakey, both Lilleheis, and Wangensteen), surgeons have advanced their practice by carefully planned and conducted studies. The principles of surgical research formulated by these leaders still pertain to the many challenges of contemporary surgery. Research results have a direct benefit when applied to the clinical sciences and patient care. Procedures that were once extraordinary, such as open-heart surgery, are now almost routine. Knowing that research is the basis for evidence-based medicine makes it obvious that interest in research facilitates the understanding and application of evidence-based principles. Principles of Research: From Idea to Publication draws on Dr Toledo-Pereyra's extensive experience as a surgeon, teacher, researcher, and research director to present profiles of accomplished scientists who exemplify the best traditions of surgical research.