190 Chapter 7 it is advised to use of multiple trained observers to assess audio-visual recordings of the surgical environment to identify and quantify possible inter-observer reliability. The group of Gjeraa et al18. advises the systematic identification of Non-Technical Skills skills in minimal invasive surgery in order to develop effective, evidence-based team training programs for minimal invasive surgeries. The present study aims to perform a structured evaluation of Non-Technical Skills in both open and robot assisted complex surgery. To investigate the manner in which the introduction of the surgical robot influences both Non-Technical Skills and outcomes surgical outcome during the first year of Robot Assisted Radical Cystectomy compared to Open Radical Cystectomy. In addition, technical skills analysis in Robot Assisted Radical Cystectomy will be performed to evaluate the possible relation between technical skills and Non-Technical Skills. The radical cystectomy was chosen for this analysis because it is a lengthy, complex and demanding surgery for surgeon and other team members. Since radical cystectomy surgeries takes many hours, a long-term and detailed analysis is possible per procedure. The radical cystectomy is traditionally performed open (Open Radical Cystectomy) at the Catharina hospital Eindhoven, but recently a shift is made to Robot Assisted Radical Cystectomy. This shift enables us to investigated in which manner Non-Technical Skills changes during the introduction of Robot Assisted Radical Cystectomy. The Non-Technical Skills during learning curve of Robot Assisted Radical Cystectomy in the Catharina Hospital Eindhoven will be compared to the Non-Technical Skills during the Open Radical Cystectomy in the same hospital as well Non-Technical Skills of an experienced Robot Assisted Radical Cystectomy team in the Antoni van Leeuwenhoek Hospital. These analyses will be performed in order to investigate in which matter Non-Technical Skills change during the introduction of the Robot Assisted Radical Cystectomy and which factors contribute to the learning curve. Results obtained during this study could be beyond Robot Assisted Radical Cystectomy since the changes in OR setup and the loss of non-verbal communication are universal when making the shift from open to robot assisted surgery.
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