We thank the authors of these three letters. Since some of the points raised have been repeated, we will address the issues rather than individual letters. This randomised controlled trial (RCT)1 was conceived to reflect the real-life scenario as practised at our institution, where only well trained surgeons with acknowledged expertise in their respective procedures did the operations. This RCT was designed to assess the results of two different surgical techniques when performed by competent surgeons, with results at least consistent with the outcomes of international multicentre publications, and allowing direct comparison of the primary and secondary outcomes of the trial. It has been known for many years that the best results are obtained by high-volume surgeons working in high throughout units,2 which was the case in this study; this RCT was designed to compare the procedures and not the surgeons, as indeed it did.