303 Analysis of the video motion tracking system ‘Kinovea’ to assess surgical movements during robot-assisted radical prostatectomy. Introduction The introduction of Endoscopic surgery opened the possibility to evaluate the surgeon’s skills based on the intra-corporal surgical videos. A standardized assessment method in order to assess the surgeon’s skills real-time in surgery was developed by Martin et al. using the Objective Structured Assessment of Technical Skills (OSATS).1 This type of skill assessment sparked the investigation into the relation between surgical skills and postoperative complications. Birkmeyer etal. were (one of) the first who were able to prove a causal relation between the level of surgical skill2 and postoperative complications. He demonstrated that the skills of the surgeons in laparoscopic bariatric surgery were associated with lower complication and mortality rates. Moreover, lower ranked surgical skills were associated with prolonged surgical times, higher reoperation rates and higher readmission rates.2 After the initial development of OSATS, various other assessment tools have been developed for the evaluation of robotic surgical technical skills, such as the Global Evaluative Assessment of Robotic Skills (GEARS)3, the Prostatectomy Assessment and Competency Evaluation (PACE)4, the Generic Error Rating Tool (GERT)5, and the PROTEST assessment tools.6 These new assessment tools can be used to assess the surgeon’s skills based on the intra-corporal video of the surgical procedure. In another study conducted by Goldenberg et al., the relationship between surgical skills defined by use of the GEARS assessment tool and patient outcomes in robot-assisted radical prostatectomies (RARP) was investigated.7 The focus of the GEARS assessment tool lies on general robot surgical principals, i.e. Depth perception, bi-manual dexterity, efficiency, force sensitivity, autonomy, and robotic control.3 Goldenberg et al. found that surgical skills as measured using the GEARS tool were ranked higher in the postoperative urinary continent group compared to postoperative urinary incontinent group.7 However, these assessment tools are a time-consuming way of assessing surgeons’ skills. Since these methods are based on human review, subjective bias cannot be avoided, leading to reduced interrater reliability. To objectify the assessment and to reduce the time investment of ‘manual assessment’ by the observer automated assessment tools are being studied.8,9 Recently Hung et al. investigated the possibility of the analysis of the movements of the surgical robot with the dVLogger system which led to greater insight into the performance of the surgeons and could be used to predict postoperative outcomes.8,10 The dVLlogger system automatically logs motion tracking and system events data without correlation to the surgery. In a recent Delphi study by our group6 into the link between surgical skills and post-
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