14 Chapter 1 less does not describe an assessment method. Apart from the general intra-operative checklist, such as the Objective structured assessment of technical skills (OSATS) 31 limited assessment tools specific for radical prostatectomy are developed. Recently, the validation of the RARP Assessment Score and Learning Curve Assessment was published.24 This multi-institutional (Europe, Australia, and United States) observational prospective study identified the high-risk steps of RARP. A specialist focus group enabled validation. Fifteen trainees who underwent European Association of Urology robotic surgery curriculum training performed RARP and were assessed by mentors using the tool developed. It remains unclear if the combination of standardized robot surgery curriculum with structured feedback using competency assessment methods influence the surgical skills of novice robot assisted surgeons and on the long-term influence postoperative outcome of patients. Surgical Skills in Expert surgeons The safety of the patient is not only guaranteed by a proper initial training, there is also an increasing demand for the implementation of clinical assessments of surgeons. Only limited initiatives have been installed to implement clinical assessment of surgeons using surgical videos.32,33 In order to optimize video assessment, it is primarily important to study the performance of the surgeon and focus on critical steps. In general surgery, several studies have been published describing assessment of intra-operative performance.34–36 Multiple standardized surgical skills assessment tools have been developed which could be used to investigate whether the differences in surgical skills in experts influence postoperative outcomes of the patients.34,37–39 Surgical skills analysis using surgical videos Analysis of past performance is a mandatory component of continues learning in many industries, yet still in its infancy in surgical assessment. Systematic evaluation of surgical skills, both technical and non-technical, is possible through video analysis methods, since laparoscopy and robot assisted surgery offer intraoperative video recordings. Post-operative outcomes in surgery could be related to surgical performance7,40, review of intraoperative videos allows for detailed analysis and improvement of skills and systems that contribute to patient safety. A detailed description of the surgery is needed in order to use the surgical videos for the assessment of surgical skills and the detection of adverse outcomes. In the past, multiple groups have devised a schedule defining the individual steps of the RARP.30,37,41 These schedules mostly are used to train new robot surgeons or to evaluate the skill of current robot surgeons but no specific schedule has been
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