102 The SMART Checklist: A Structured Tool for Reporting Modifications in Upper GI Surgical Innovation

Abstract Aim To present the SMART (Surgical ModificAtion Reporting Tool) checklist for reporting modifications in surgical innovation and outline future directions for its implementation and evaluation in upper gastrointestinal (UGI) surgery. Method The SMART checklist was developed from a systematic review of modification reporting in IDEAL-cited studies, followed by iterative optimisation through qualitative interviews with key stakeholders, including UGI surgeons. The checklist was refined based on thematic analysis of stakeholder feedback, ensuring its clarity, comprehensiveness, and clinical relevance. Results The SMART checklist provides structured guidance for systematically documenting modifications to innovative surgical procedures and devices, with specific attention to the rationale, timing, context, and impact of both device and procedure changes. It includes summary items to encourage reflection on an innovation’s stability and lessons for shared learning. Stakeholders recognised the checklist’s potential to enhance transparency, reduce research waste, and improve patient safety. Anticipated barriers to implementation include time constraints and the need for integration with existing clinical systems. Facilitators include the checklist’s clarity, stakeholder co-design, and alignment with established reporting standards. Conclusions The SMART checklist addresses a critical gap in UGI surgical innovation by standardising modification reporting. Its adoption is expected to support safer and more efficient innovation, facilitating shared learning across the surgical community. Future work will focus on prospective piloting, electronic integration, and evaluation of its impact on reporting quality and patient outcomes in multiple specialities, including UGI surgery.