177 Linking surgical skills to postoperative outcomes: a Delphi study on the robot assisted radical prostatectomy Discussion The aim of this study was to develop an assessment instrument for the evaluation of surgical videos to elucidate the association between surgical skills and postoperative outcomes after a robot-assisted radical prostatectomy (RARP). To investigate this association, we invited all Dutch experts in RARP to participate in a standardized Delphi procedure in order to identify surgical and non-surgical factors in RARP that are potentially associated with an adverse postoperative course and to assess whether any of these parameters may be worth evaluating for the prediction of postoperative outcomes. We found that the majority of Dutch urologists specialized in RARP are interested in an instrument for video analysis of their surgical skills in relation to the postoperative outcomes. These urologists indicated that they were interested to participate in the current study because they considered video analysis to be useful for the improvement of surgical skills and the subsequent reduction of postoperative complications. Consensus group meeting During the consensus group meeting the panel members agreed that the duration of the surgical procedure and the duration of coagulation could be causally related to the rate of postoperative complications. They advised to investigate whether such a causal relation exists. The panel also agreed there could be a causal relation between the duration of coagulation and the level of adverse postoperative functional results. The panel agreed that postoperative complications, postoperative erectile dysfunction and postoperative urinary incontinence could result from events during the following steps of the RARP procedure: “Pelvic floor muscle exposure/opening of the endopelvic fascia”, “Bladder neck dissection”, “Ligation of prostate pedicles”, “Nerve preservation”, “Management of prostate apex/urethra”, “Vesico-urethral anastomosis”, “Lymph node dissection”, and “Wound closure and specimen removal”. The panel agreed that these steps should be incorporated in an assessment instrument to investigate whether they are related to adverse postoperative outcomes. PROTEST assessment instrument Based on the consensus reached during the Delphi Survey and the consensus meeting, the PROTEST assessment instrument was developed (Table 5). This instrument can be used to assess the skills of a surgeon through analysis of a video recording of the surgery. This assessment instrument was developed with the input of the panel members and
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