Surgical innovation is something of a grey area in medical research. Relative to other doctors, surgeons exercise a high degree of discretion in the trialing of new techniques with their patients. The first patients to undergo a new procedure are, in a real sense, subjects in an experiment. It is always hoped that a new procedure will deliver a clinical benefit but, as often as not, trial means error. The front-line patients bear a higher burden of risk, with lower expectation of success than subsequent patients, who benefit from the experience gained in the early attempts.