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Surgery has been slowly changing over the past few decades; it is becoming clearer what evidence should guide us in our decision making. Gone are the days when surgical giants merely suggested a treatment philosophy or procedure with its almost immediate acceptance. Surgeons, patients, and even payers in today's health care environment are demanding high levels of evidence to justify clinical choices and validate those concepts we have held dear for decades. Standards are pushed higher and patient care is improved. The work presented here represents a process of assimilation of thought in various exciting new areas, not just one individual or group's eureka moment. The contributors to this issue have unique skills that not only include surgical excellence but also represent exceptional surgical thinking with an ability to transform ideas into new surgical principles. These new ideas are presented to you for further debate and perhaps for assimilation into mainstream practice.
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