An operative technique section is reproducible when another surgeon could repeat the operation from the text alone. Report positioning, anaesthesia, the approach and incision, instruments and materials by name and size, the steps in the order performed, the decision points and what governed them, closure, and any deviation from the standard technique with the reason.
An operative technique section is a method, not a narrative
The operative technique section is the methods section of a surgical paper. Its purpose is not to record one day in one theatre, but to specify a procedure precisely enough that a surgeon elsewhere could carry it out, and that a reader can judge whether your results follow from it.
Narrative sentences carry impressions rather than actions. "The dissection proceeded uneventfully" gives a reader nothing to repeat, and "haemostasis was secured in the usual fashion" names no device, no setting, no endpoint. Apply one test to each sentence: alone, could a reader order the equipment, position the patient and know when the step is finished? If not, you have written a story where a method belongs.
The elements a reproducible operative description must contain, in order
Write the operative description in the order the operation happens, so a reader never jumps back for a detail needed three steps ago. The table is a running order, not subheadings.
| Element | What to state | The detail to check |
|---|---|---|
| 1. Indication and selection | Criteria for offering the operation, and what excluded it | Why the alternative was rejected |
| 2. Preparation | Imaging, skin or bowel preparation, antibiotic prophylaxis by drug, dose, timing | Timing relative to incision |
| 3. Anaesthesia | Type, regional blocks, invasive monitoring, relaxation affecting the field | Whether blocks preceded induction |
| 4. Positioning and setup | Position, degrees of tilt, limb placement, padding, where surgeon and screens stand | Degrees of tilt |
| 5. Access | Incision site and length in centimetres, port diameters, distance from a landmark, insufflation pressure | The landmark ports are measured from |
| 6. Instruments and materials | Device type, energy modality and power, mesh or graft and size, suture material and gauge | Energy settings and suture gauge |
| 7. Steps in sequence | One action per numbered step, with its opening landmark and its endpoint | The endpoint of each step |
| 8. Safety checks | The view or measurement satisfied before an irreversible step, and how documented | Whether the check was recorded |
| 9. Decision points | The finding that changed the plan, the rule applied, the alternative performed | The threshold between courses |
| 10. Specimen handling | Extraction route, retrieval bag, orientation marking, fixation | Orientation marking |
| 11. Haemostasis and closure | Layers, suture per layer, drain type, size and exit site, dressing | Drain size and exit site |
| 12. Postoperative protocol | Analgesia, feeding, mobilisation, drain removal and discharge criteria | Criteria, not the usual day |
| 13. Operator | Grade and caseload of the operating or supervising surgeon, unnamed | Whether a trainee operated |
The same step, written twice: weak versus reproducible
A weak operative description and a reproducible one differ in a single step. Both versions describe the same part of a laparoscopic cholecystectomy.
Weak: the step written as narrative
The gallbladder was dissected free from the liver bed in the usual fashion using diathermy. Once the anatomy had been clearly identified, the cystic duct and artery were clipped and divided.
Reproducible: the same step, rewritten
The fundus was retracted cephalad with a 5 mm grasper through the right subcostal port, and the infundibulum retracted laterally to open the hepatocystic triangle. The peritoneum was divided over the anterior and posterior aspects of the infundibulum with a hook electrode set to 30 W monopolar coagulation. Dissection continued until the critical view of safety was satisfied: two and only two structures seen entering the gallbladder, the lower third of the gallbladder separated from the cystic plate, and the hepatocystic triangle cleared of fat and fibrous tissue. The critical view was recorded as a still image before any structure was divided. The cystic duct and the cystic artery were each closed with two medium-large titanium clips proximally and one distally, and divided with cold scissors.
Four things changed, none stylistic:
- Named instruments and settings replace "diathermy".
- A stated endpoint replaces "clearly identified": the critical view of safety, written out in full.
- A followable order replaces "in the usual fashion".
- Evidence that the check happened replaces the assumption that it did.
Report an instrument so a reader could obtain the same item and set it identically: the generic type, size and setting, then the device name and manufacturer in parentheses, which is what the ICMJE recommendations ask for. Naming the generic first keeps the method usable where a product has been discontinued or unavailable in the reader's country. A commercial relationship with a manufacturer belongs in the competing interests declaration.
Write decision points as rules a reader could apply
A decision point is a moment where a finding changed what was done next. Narrative writing collapses decision points into hindsight: "the plane was hostile, so an open approach was used", which tells a reader nothing about when to convert. Write each decision as a conditional rule with a threshold, then give the number of cases in each branch. The example below is constructed:
If the critical view of safety could not be achieved after 30 minutes of dissection of the hepatocystic triangle, or if bleeding obscured the field on two occasions, the procedure was converted to a subtotal fenestrating cholecystectomy, with the remnant left open and a drain placed in the gallbladder fossa. This occurred in 4 of 62 operations.
Written that way, the decision point is testable: a reader can adopt your threshold, reject it, or explain a different conversion rate by pointing at the rule rather than unmeasured judgement.
State what you did differently from the standard technique, and why
A technique paper earns its place through the modification, so isolate it from the routine around it. Report it in four parts:
- The reference technique. Name the standard operation and cite the paper describing it, so the reader has your baseline.
- The modification. State which step changed, in the same terms used elsewhere in the operative description.
- The reason. Give the problem it solves: an anatomical constraint, an equipment limitation, a step you judged unsafe.
- The scope. Say whether it was used in every case or some, how many, and whether it was planned or adopted mid-operation.
The fourth part is the one that decides how the modification reads: a modification used in nine of thirty cases, three as a rescue, is a different claim from one applied consistently by design.
Keep outcomes out of the operative technique section
The operative technique section reports what was done; anything measured afterwards belongs in the results: operative time, blood loss, conversion rate, length of stay, complications and follow-up findings. Definitions stay with the method: if you graded complications, name the grading system and observation window there, then report the grades in the results. Counts attached to a decision rule are the one exception: how many cases took each branch defines what the technique covers, so give the bare numbers with the rule and analyse the rate in the results.
Write the operative description so a double-blind reviewer cannot identify your centre
Peer review at Directive Publications is double-blind, and an operative description carries several routes by which author identity can leak. Report the device, the setting and the step; do not name the local care pathway, the institutional protocol or the unit, and cite your own earlier work in the third person. Video and photographs carry identity in overlaid text, file names and metadata, so strip those before the files leave your computer. Where an image could identify a patient rather than an author, our author guidelines ask for separate, explicit consent for publication of any identifiable data or images.
A pre-submission check for the operative description
Read the operative description against this list. Each item answers yes or no.
- Could a reader obtain every instrument, implant and suture, at the right size?
- Is every energy source reported with its modality and setting?
- Does each step have a stated endpoint?
- Is the position given as degrees of tilt and limb placement?
- Are incisions and port sites given with size and a measured landmark?
- Is every decision point a rule with a threshold, and a count per branch?
- Is the departure from the standard technique named, justified and scoped?
- Are closure, drains and aftercare as detailed as the dissection?
- Have "usual", "routine" and "as described previously" gone, replaced by content or a citation?
- Does anything identify your centre, your unit or your patients?
Surgical reporting checklists are held by the EQUATOR Network, alongside the manuscript requirements of the ICMJE. Our author guidelines ask you to match your manuscript to the relevant EQUATOR checklist; we publish no operative-description checklist of our own. See Article Types, then how to write and publish a case report, preparing supplementary materials for operative video, and writing clear scientific English if the narrative habit is hard to break.