318 Chapter 12 is more reliable. When checking these manual sudden movements, they appeared to be caused by manual repositioning of the tracking point on the instrument by the researcher after the tracking point had lost the instrument’s joint during automated analysis by the Kinovea program. During the assessment of the videos an average of 101 manual repositioning’s were registered. This makes the sudden movements unreliable for analysis in robot assisted surgery, which could mean the automated results represent a more accurate analysis of the surgical movements. The group of Ganni, et al did not report this problem, either because no manual repositioning was necessary in their study or because they did not manually review the entire surgical video9. Relation between Kinovea results and postoperative continence status This study shows there is no relation between the motion tracking results and the continence status of this patients. The main reason could be the limited quality of the Kinovea Motion tracking results since on average less than a quarter of the videos could be tracked. Another explanation could be there is no relation between the total path length, average speed of the instrument and the continence status of the patient. Relation between Kinovea results of different phases of the surgery and postoperative continence status The correlation between Kinovea results of the “Pelvic floor muscle exposure/opening of the endopelvic fascia”, and the “Vesico-urethral anastomosis” to the PROMS results also did not give any significant correlations. Since the value of the results using the Kinovea program is questionable the lack of correlation could be due to the fact that only limited parts of the surgery were analysed or it could mean the results obtained using Kinovea cannot be used to predict postoperative continence. Since the Kinovea software was not able to automatically assess surgical movements in RARP it proved to be an invalid tool for automated surgical movement tracking in robot assisted surgeries. Strengths and limitations. To our knowledge this is the first study into the possibilities of using existing surgical videos of real RARP procedures to identify the effects of surgical movements on postoperative outcome. This study shows the results of the first use of Kinovea as a software based surgical motion tracking tool in robot assisted surgery. Although the
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