242 Chapter 9 population. The comments from the experts to the relatively accurate prediction of continence outcome learned that urethral length and urethra thickness were considered when continence was scored by experts. Urethral sphincter length as assessed by MUL assessed on MRI and in the removed prostate specimens was found a strong predictor of post-prostatectomy continence21–23. Therefore, objectively measuring intra-operative urethra stump length may improve prediction and is subject of further study. The results of these assessment methods combined with intra-operative measurements and automated performance metrics analysis developed by Hung et.al.10 could be used to improve surgeons’ skills and improve the patient’s postoperative outcome. A combination of patient and surgeon data could be used to develop a personalized prediction model for both continence and potency after RARP. The group of Stern et.al. have performed a study into a single surgeon’s prediction of continence based on the quality of bladder neck preservation, cavernous nerve sparing, urethral length, quality of anastomosis, striated sphincter thickness, quality of posterior reconstruction, and quality of bladder neck plication stitch.27 The surgeon was asked to score each factor directly after the surgery with either the verdict “bad”, “average” or “good”. They did not find any correlation between the investigated factors and postoperative continence. Since the assessment of the surgeon was directly postoperative and not based on the revision of the surgical video the verdict of the surgeon could have been influenced by other factors, for example, distracting factors in the operating room, rather than solely the factors analysed during the surgery. Surgical video assessment templates The second objective of this study was to investigate whether results of the GEARS, PACE and PROTEST assessment methods could be related to postoperative outcome defined as continence and erectile function. Although the GEARS, PACE, and PROTEST analysis can be used to assess surgical skills, results showed no significant difference between the incontinent and continent patients nor between impotent and potent patients. The factors assessed by the experts are not included in either templated assessment method, addition of factors in the templated assessment methods such as assessment of the urethral length could increase their use in the prediction of postoperative outcome. Although the results of this study do not show it, the factors analysed in the different assessment methods have been found to be of influence in other studies in the origins of poor postoperative outcome. The group of Goldenberg et al. have reported the mean overall GEARS scores as an independent predictor of postoperative continence in 47 patients (24 incontinent vs. 23 continent).9 A possible explanation for the
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