329 General discussion, conclusions, and future perspectives General discussion This thesis focusses on the training and assessment of surgical skills in robot assisted surgery. In the past years the introduction of new technologies such as the surgical robot has resulted in an increasing number and a large variation of procedures together with an enhance level of levels of technical difficulty . The challenge for both novice and expert surgeons is to safely learn how to perform new surgical procedures and to integrate these technologies into existing surgeries. To be sure that these new procedures are safe for patients, surgical practise directed at the new methods of quality assurance should be developed and investigated to guarantee the proficiency of the surgeon and improve surgical outcome. An example of a novel method of quality assurance is the analysis of sugical performance by means of video’s to find out how to improve surgical procedures The aim of this thesis is twofold. First, is to gain insight into the training and assessment of surgical skills of both novice and expert surgeons in robot assisted surgery. Second, is to clarify the relationship between performance of expert robot surgeons and postoperative patient outcomes. The main research questions of this thesis are: 1. What are the best methods to educate novice surgeons in robotic surgery? 2. How can the performance of robotic surgeon’s best be assessed? 3. What is the relation between a surgeon’s performance and a patient’s postoperative outcomes? We will discuss the main findings of the thesis per research question, and highlight methodological considerations. We conclude this chapter with a reflection on the main findings of this thesis in relation to the current literature and recommendations for future research and clinical practice. Research questions 2 and 3 are intrinsically linked, in this thesis we first researched the best method for the assessment of surgical performance using surgical video assessment (research question 2). The results of research question 2 form the basis for the research into question 3 in which we compare the surgical performance results to the patient’s postoperative outcome. What are the best methods to educate novice surgeons in robotic surgery? The studies presented in this thesis show that there is a need for structured training in robot assisted surgery (RAS). General guidelines and certification criteria have been set for laparoscopic surgery in the form of the European Basic Laparoscopic Urological
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