266 Chapter 10 Discussion There is an increasing interest in the use of surgical video analysis in research.32 In order to standardize surgical skills assessment using video analysis, multiple templates have been developed by different research groups.20–23 In this study, we investigated whether the multiple assessment methods for surgical videos can be used to identify factors that could influence potency levels after prostatectomy. Existing video assessment methods were compared to the opinions of expert surgeons by video analysis of RARP surgeries. Are expert surgeons able to predict postoperative potency levels by performing surgical video analysis? The results of this study show the expert who performed the surgery was able to correctly assess the potency status of the patients in most cases. Expert 2 was less successful in the assessment of the potency status of the patients. Both surgeons were asked to describe the factors of the surgery that they used to predict the potency of the patients. Although these factors were similar for both surgeons, the interpretation of these factors seemed to differ per surgeon. Both experts felt the level of NVB preservation, the quality of the NVBs and the means of haemostasis during NVB preservation were associated with the level of potency of the patients. It is known, based on a study by Ong et al., haemostatic energy sources in proximity to the prostate in dog models can lead to a decrease in erectile function in comparison to dogs where no haemostatic energy sources were used during dissection.33 The result shows there is a difference in the interpretation of the level of NVB preservation, since Expert 1 and Expert 2 disagree on the level of nerve-sparing in multiple patients. There is also a difference in the interpretation of the method of haemostasis in the patients. Since Expert 2 indicates the use of a haemostatic energy source in more patients compared to Expert 1, this shows there is a difference in the interpretation of the use of a haemostatic energy source between the experts. The differences in interpretation of the experts of the use of a haemostatic energy source and the level of NVB preservation between the experts could thus explain the differences in the ability of the experts to predict postoperative outcomes. This is the first study showing the difference in the interpretation of the dimensions of structures in surgical videos by different surgeons. This shows there is a need for the development of objective measurements in surgical video analysis in order to standardize assessment and clarify the influence of the factors identified by the experts on the patient’s postoperative potency status. Multiple groups are investigating the use of objective surgical skills assessment in robot-assisted surgery.34–40 These initial studies are a first step
RkJQdWJsaXNoZXIy MTk4NDMw