236 Chapter 9 video analysis using GEARS, PACE and PROTEST. Since we did not expect any sequence effects due to the differences in focus in the assessment methods no counterbalancing or randomisation of assessment methods was performed. 1. Videos were evaluated using the Global Evaluative Assessment of Robotic Skill (GEARS).8 The focus of the GEARS assessment method lies on general robot surgical principals, i.e. depth perception, bi-manual dexterity, efficiency, force sensitivity, autonomy, and robotic control.8 The GEARS assessment method is scored on 5 aspects of surgical skills (Depth perception, Bi-manual dexterity, Efficiency, Force sensitivity, Robotic control) using a 5-point Likert scale; minimum score is 5 the maximum score is 25. 2. Videos were evaluated using the Prostatectomy Assessment and Competence Evaluation (PACE).6 The PACE assessment method focusses on surgical skills using specified steps of the RARP procedure. This method is mainly used to define deficits in the surgeon’s skills in order to provide surgeon specific training to improve surgical skill. The PACE assessment method consists of assessment of six domains with 10 sub-domains which are scored on 5-point Likert scales; minimum score is 10 the maximum score is 50. 3. Videos were evaluated using the PRostatectomy video Observation to Evaluate and Score Technical skill (PROTEST) Assessment method developed by this research group.17 The PROTEST assessment method gives detailed insight into the proficiency of the surgeon on each of the individual surgical steps of the RARP. It combines the answers to two general subjective questions with multiple objective measurements in order to provide detailed feedback to the surgeon. The process of surgical video analysis The surgical video was assessed in two phases, first the PROTEST assessment was performed for the entire surgical video using customizable video analysis software “digital Video Coach” developed by ZEAL IT (figure 2). Secondly the PACE and GEARS assessments were performed simultaneously by reviewing the surgical video in a normal media player. The GEARS score was calculated for the entire surgery. The video analysis software “Digital Video Coach” made it possible to measure the length of the phases of the surgery and the length of the different peri-operative events. Two sets of labels were created in order to define the different phases of the surgery and the different peri-operative events. The selection of one of the labels automatically marked the time code corresponding to the moment the label was pressed. This made it possible to measure the duration of the phases and peri-operative events. The labels used for this analysis are given in figure 3. The steps cor-
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