241 Identifying surgical factors predicting postoperative urinary continence in robot-assisted radical prostatectomy Discussion In this study we investigated whether the assessment of surgical videos is useful to predict functional outcomes after prostatectomy. Existing scoring methods were compared to expert surgeons’ opinion by video-analysis of RARP surgeries of the prostate apical dissection phase, and vesico-urethral anastomosis phase and assessment of the neurovascular bundles? Are expert surgeons able to predict postoperative functional outcomes by performing surgical video analysis? This study shows both experts were able to predict potency in most patients. Expert 1 was able to predict the postoperative continence status in 66.7% of the patients. This is represented in the almost perfect level of agreement between the postoperative status and the results of Expert 1. Expert 2 was able to predict the postoperative continence status in 33.3% of the patients. Especially the prediction of incontinence in patients seemed more difficult for Expert 2. The self-assessment of Expert 1 and independent assessment of Expert 2 reached a slight level of agreement between their assessments. In case of continency both experts agree a good length and thickness of the urethral stump could be associated with increased chances of continence. Although the influence of the urethral length on postoperative continence has been reported in both MRI and pathological studies 21–24 this relation has not yet been investigated using surgical video assessment. In addition, Expert 2 felt the use of thermal dissection during the dissection of the urethra could negatively influence the continence of patients. Expert 1 focussed more on the level of bladder neck preservation and/or reconstruction in patients, a narrower bladder neck/bladder neck reconstruction prior to anastomosis could be associated with higher incidences of continence. The fact that Expert 1 was better able to correctly predict both incontinence and continence in patients could be due to the fact that this type of assessment is a type of self-assessment, although the most recent surgery was of July 2016 (with an average of 200 surgery’s per year), Expert 1 could recognise some surgical techniques which could help him in predicting the continence status of the patients. Another reason for the success of Expert 1 could be due to the fact that he looked at different peri-operative factors than expert 2. This could indicate a higher influence of a narrower bladder neck/bladder neck reconstruction25,26 on the level of continence compared to the influence of thermal dissection during the dissection of the urethra. It is difficult to prove this statement based on the results of this study due the small size of the study
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