To address the persistent challenges in surgical clinical research, we provide a comprehensive analysis of the series of articles on randomized controlled trials (RCTs) methodology guidance published in JAMA Surgery from 2022 to 2023. This section contents focus on critical aspects of RCTs, including trial design, selection criteria, ethical considerations, quality control, and budgeting and funding support. The objective is to enhance the understanding of RCTs among researchers, particularly surgeons, thereby guiding them in conducting high-quality and scientifically robust RCTs.