Innovation is defined by the dictionaries as “a new idea, device, or method; or the act or process of introducing new ideas, devices, or methods.” However, Surgical Innovation (SI) is more difficult to define. Common narratives include why-where-how-what-who as well as novelty, degree of change, safety, ethical standards, level of impact and peer acceptance. [1, 2] We have proposed a simpler, more egalitarian and ‘inclusive’ definition: “a SI is ‘any’ new surgical idea which improves patient welfare by solving an existing problem; and which like a three-legged stool is balanced by the three legs which represent surgical-precision, surgical-wisdom and patient-safety”. 
Frugal Surgical Innovations (FSIs) are low-cost surgical innovations which are designed for economic reasons. These are all about ‘doing more and better with less for more people’.  FSIs make up for their lack in sophistication or complexity in affordability, without scrimping on safety or effectiveness. The three constructs of FSIs are: affordability, adaptability and accessibility.  The philosophy of FSIs originates from grassroots, resource-constrained settings (RCS), where most abundant of all-natural resources — human ingenuity — is used to optimize limited resources to solve problems.  Clinically meaningful inclusive research can be performed ‘only’ by surgeons working in RCS; as ‘only’ they understand the difficulties and nuances of various problems and can provide simple affordable solutions for their patients. 
Birchley G, Ives J, Huxtable R, Blazeby J. Conceptualising Surgical Innovation: An Eliminativist Proposal. Health Care Anal. 2020 Mar;28(1):73-97. doi: 10.1007/s10728-019-00380-y.
Hutchison K, Rogers W, Eyers A, Lotz M. Getting Clearer About Surgical Innovation: A New Definition and a New Tool to Support Responsible Practice. Ann Surg. 2015 Dec;262(6):949-54. doi: 10.1097/SLA.0000000000001174.
Sharma D, Agarwal P, Agrawal V. Surgical innovation in LMICs-The perspective from India. Surgeon. 2022 Feb;20(1):16-40. doi: 10.1016/j.surge.2021.11.002.
Prabhu J. Frugal innovation: doing more with less for more. Phil.Trans.R.Soc.A 2017; 375: 20160372. DOI: 10.1098/rsta.2016.0372
Bhatti Y, Prime M, Harris M, Wadge H, McQueen J, Patel H, Carter A, Parston G, Darzi A. The search for the holy grail: frugal innovation in healthcare from low-income or middle-income for reverse innovation to developed countries. BMJ Innovations 2017;0:1–9. doi:10.1136/bmjinnov-2016-000186.
Radjou N. The genius of frugal innovation. https://ideas.ted.com/the-genius- of-frugal-innovation/ Mar 21, 2017. Accessed on 2nd January 2021.
Sharma D, Agrawal V, Agarwal P. Editorial: Roadmap for clinical research in resource-constrained settings. Tropical Doctor 2021; 51(1): 4–5. DOI: 10.1177/0049475520974844.
Sharma D, Harris M, Agrawal V, Agrawal P. Plea for standardised reporting of frugal innovations. BMJ Innovations 2021;7:642-646. DOI: 10.1136/bmjinnov-2021-000710.
McCulloch P, Altman DG, Campbell WB, Flum DR, Glasziou P, Marshall JC, et al. No surgical innovation without evaluation: the IDEAL recommendations. Lancet. 2009 Sep 26;374(9695):1105-12. doi: 10.1016/S0140-6736(09)61116-8.
Macefield RC, Wilson N, Hoffmann C, Blazeby JM, McNair AGK, Avery KNL, Potter S. Outcome selection, measurement and reporting for new surgical procedures and devices: a systematic review of IDEAL/IDEAL-D studies to inform development of a core outcome set. BJS Open. 2020 Oct 4. doi: 10.1002/bjs5.50358.
Roberts DJ, Zygun DA, Ball CG, Kirkpatrick AW, Faris PD, James MT, et al. Challenges and potential solutions to the evaluation, monitoring, and regulation of surgical innovations. BMC Surg. 2019 Aug 27;19(1):119. doi: 10.1186/s12893-019-0586-5.
Miller ME, Siegler M, Angelos P. Ethical issues in surgical innovation. World J Surg. 2014 Jul;38(7):1638-43. doi: 10.1007/s00268-014-2568-1.
Barnett SJ, Katz A. Patients as partners in innovation. Semin Pediatr Surg. 2015 Jun;24(3):141-4. doi: 10.1053/j.sempedsurg.2015.02.014.
Hearld L, Alexander JA, Wolf LJ, Shi Y. Dissemination of quality improvement innovations by multisector health care alliances. J Health Organ Manag. 2019 Jun 28;33(4):511-528. doi: 10.1108/JHOM-08-2017-0195.
Massoud MR, Nielsen GA, Nolan K, Schall MW, Sevin C. A Framework for Spread: from Local Improvements to System-Wide Change. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2006.
Berwick DM. Disseminating innovations in health care. JAMA. 2003 Apr 16;289(15):1969-75. doi: 10.1001/jama.289.15.1969.
Weiser TG, Forrester JA, Negussie T. Implementation science and innovation in global surgery. Br J Surg. 2019 Jan;106(2):e20-e23. doi: 10.1002/bjs.11043.
Sharma D, Agrawal V, Sam-Agudu NA, Agarwal P, Yadav SK, Bajaj J. ‘DISSEMINATE’: a conceptual framework for facilitating adoption of affordable surgical innovations in low-and middle-income countries. BMJ Innovations: In Press.
Bath M, Bashford T, Fitzgerald JE. What is 'global surgery'? Defining the multidisciplinary interface between surgery, anaesthesia and public health. BMJ Glob Health. 2019 Oct 30;4(5):e001808. doi: 10.1136/bmjgh-2019-001808.
Sharma D. Editorial: Global Surgery: Advent of a new discipline. Pakistan Journal of Medical and Health Sciences: 2022; 16 (3): 1. DOI: 10.53350/pjmhs221631.
Mission statement, Centre for Global Surgical Innovation and Low Cost Solutions, Department of Surgery, Government NSCB Medical College and Allied Hospitals, Jabalpur, India 482003. Available from https://www.surgicalinnovations.in/home.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright (c) 2023 Array