331 General discussion, conclusions, and future perspectives patient.7–9 The results of a survey among participants in the structured fellowship in RAS (CCERUS fellowship) showed most respondents still perform RAS after the fellowship, which matches results from other studies into the impact of RAS fellowships.10,11 A remarkable finding of this study is that a large proportion of respondents are unaware of the oncological (33%) and functional outcomes (66%) of their patients. This shows the participants of RAS fellowships should be urged to review their own results in order to learn from their past performance to improve their future surgical results. How can the performance of robotic surgeon’s best be assessed? The studies performed in this thesis show technical skills assessment can be performed using multiple methods. Where the skills of novice surgeons are commonly assessed using the virtual reality simulator, expert surgeon’s commonly use surgical video assessment and postoperative patient outcome analysis. In order to use the surgical video as an assessment method, the steps of the Robot Assisted Radical Prostatectomy (RARP) surgery must be defined to relate adverse postoperative outcome and complications to steps in the surgical process. In this thesis the steps of the RARP surgery and corresponding peri-operative events with a possible effect on postoperative outcome (urinary continence and potency) of patients were defined. A new assessment template, the PROTEST assessment method, was designed based on these findings. Although several assessment methods exist these methods only focus exclusively on aspects of surgical skills assessment12–14. The PROTEST assessment method combines subjective surgical skills assessment, objective metrics of procedural steps, and events in one assessment method. The analysis of technical surgical skills in RAS can lead to, mayor improvements of postoperative outcomes through the introduction of mandatory periodical assessment and training programs.15 However, the influence of Non-Technical Skills (NTS) such as communication, teamwork, leadership, and situational awareness on postoperative outcomes should not be forgotten. In this thesis we present a study protocol describing a prospective observational multicentre study into non-technical-skills (NTS) in both Open Radical Cystectomy (ORC) and Robot Assisted Radical Cystectomy (RARC). We propose a structured approach to NTS assessment using video and audio recordings from the operation room to be able to implement all different NTS scoring methods.16–21 The results of this study can be used to develop team-training programs specifically tailored to the introduction of the surgical robot in relation to changes in
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