What are potential randomized controlled trial (RCT) topics for a general surgery resident's thesis?

Potential RCT Topics for General Surgery Residents' Thesis

For a general surgery resident's thesis, focus on designing randomized controlled trials that address clinically relevant questions with feasible implementation and potential to impact patient outcomes. While single-center RCTs should be considered hypothesis-generating rather than definitive evidence 1, they remain valuable for thesis work when designed with methodological rigor.

Considerations for Selecting an RCT Topic

Methodological Considerations

• Select a topic that can be feasibly conducted within the constraints of residency training, considering sample size requirements and follow-up periods 1
• Focus on patient-centered outcomes that prioritize morbidity, mortality, and quality of life rather than surrogate endpoints 1
• Consider the PICO framework (Population, Intervention, Comparison, Outcome) to clearly define your research question 1
• Ensure adherence to reporting guidelines such as CONSORT to enhance transparency and reproducibility 1

Clinical Areas with Research Potential

Minimally Invasive Surgery

• Comparison of different laparoscopic techniques for common procedures (e.g., cholecystectomy, appendectomy) with focus on patient-reported outcomes 2
• Evaluation of enhanced recovery protocols specific to minimally invasive procedures versus standard care 2
• Assessment of novel technologies in laparoscopic surgery against established techniques 3

Perioperative Care

• Digital home monitoring systems versus standard care for post-discharge surgical recovery 2
• Comparison of different multimodal pain management protocols to reduce opioid consumption after specific procedures 2
• Evaluation of preoperative optimization strategies for high-risk surgical patients 4

Wound Care and Surgical Site Infections

• Comparison of different wound closure techniques and their impact on surgical site infections and cosmetic outcomes 5
• Evaluation of novel dressing materials versus standard dressings for complex wounds 3
• Assessment of antibiotic prophylaxis protocols for specific surgical procedures 4

Surgical Oncology

• Comparison of different surgical approaches for specific cancer types with focus on oncological outcomes and quality of life 6
• Evaluation of neoadjuvant therapy protocols combined with surgery versus surgery alone 6
• Assessment of surgical margins and their impact on recurrence rates 5

Practical Implementation Tips

Study Design Considerations

• Clearly define primary and secondary outcomes before initiating the study 1
• Consider feasibility of blinding (patient, assessor, or both) where applicable 4
• Plan for appropriate follow-up periods that capture relevant outcomes 1
• Include patient-reported outcome measures alongside clinical endpoints 1

Overcoming Common Challenges

• Address potential recruitment challenges by establishing clear inclusion/exclusion criteria and streamlined consent processes 3
• Consider a pilot study to assess feasibility before full implementation 2
• Collaborate with statisticians early in the design phase to ensure appropriate sample size calculations 4
• Establish standardized protocols for interventions to reduce variability 5

Ethical Considerations

• Ensure equipoise exists between treatment arms 6
• Obtain appropriate institutional review board approval 1
• Develop clear protocols for handling adverse events 1
• Register your trial protocol before initiating recruitment 1

Promising Specific RCT Topics

1. Comparison of early versus delayed cholecystectomy for acute cholecystitis in elderly patients with comorbidities 5
2. Evaluation of different mesh fixation techniques in laparoscopic ventral hernia repair 3
3. Impact of preoperative immunonutrition on postoperative outcomes in colorectal cancer surgery 1
4. Comparison of different drain management protocols after pancreatic surgery 6
5. Evaluation of intraoperative near-infrared fluorescence imaging for identifying critical structures during laparoscopic procedures 4
6. Assessment of different closure techniques for fascial defects after laparoscopic port removal 3
7. Comparison of different postoperative mobilization protocols after major abdominal surgery 2
8. Evaluation of different hemostatic agents in hepatic resection 5
9. Assessment of different surgical approaches for pilonidal sinus disease 6
10. Comparison of different techniques for parastomal hernia prevention in ostomy creation 4

Remember that while single-center RCTs may have limitations, they provide valuable training in clinical research methodology and can generate important hypotheses for future multi-center trials 1.