260 Chapter 10 autonomy, and robotic control).21 The GEARS method is scored on five aspects of surgical skills (depth perception, bimanual dexterity, efficiency, force sensitivity, and robotic control) using a 5-point Likert scale; the minimum score is 5, while the maximum score is 25. The GEARS score was calculated for the entire surgery. The score represents the surgeon’s mastery of and surgical skills on the surgical robot. (ii) The Prostatectomy Assessment and Competence Evaluation (PACE).23 The PACE method focuses 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 method consists of an assessment of 10 subdomains divided over six domains, which are scored on 5-point Likert scales; the minimum score is 10, while the maximum score is 50. (iii) The PRostatectomy video Observation To Evaluate and Score Technical skill (PROTEST) method was developed by this research group.22 The PROTEST method gives detailed insight into the proficiency of the surgeon on each of the individual surgical steps of the RARP. This assessment method consists of two general subjective questions, multiple objective measurements, and 11 surgery-specific questions in order to provide detailed feedback to the surgeon. The two general subjective questions provide an assessment of the coordination and accuracy of the surgeon. These questions are scored on 5-point Likert scales, with the minimum score per phase being 2 and the maximum score being 10. Per surgery, the minimum score is 14, while the maximum score is 70. The objective measurements consist of the total duration of a phase, the instances and total duration of bleeding during a phase, the instances and total duration of coagulation during a phase, the instances and total duration of suturing during a phase, and the instances and total duration of camera removal during a phase. In addition, the rater was able to record comments and or events that were remarkable during the phase. The 11 surgery-specific questions consist of 10 Yes/No questions and one counting question. These questions focus on if some technical aspects of the surgery were either visible or performed during this specific surgery. The following subjects were covered in this part of the assessment method: (i) Was bladder neck preservation attempted (Y/N)? (ii) Were both ureteral orifices in sight during preparation of the bladder neck? (Y/N) (iii) Was the capsule damaged during nerve-sparing? (Y/N) (iv) Was there a tear in the vesiculae during preparation? (Y/N)
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