334 Chapter 13 Methodological considerations This thesis is divided in three themes, the training of novice robot surgeons, the performance assessment of expert robot surgeons, and the investigation of the relationship between a surgeon’s performance and a patient’s postoperative outcomes. A limitation of the studies in this thesis is the use of multiple surveys to gain insight into the experiences of trainees after standardised surgical training programmes, effects of interventions and opinions of robot surgeons. Although the response rate on these surveys was high, the missing responses always form a potential source of bias. The addition of interviews to some of the questionnaires might have resulted in richer data and a higher response rate, but this also could have resulted in more socially desirable answers. Participants for the survey studies were carefully selected, although this careful selection inherently leads to selection bias this choice was made to gain a clear insight into the opinions of experts or the experiences of novice surgeons. Most of the questionnaires used in this thesis were specifically created for this thesis since no pre-validated questionnaires exist on these subjects. A group of 7 experts were asked to assess the face validity of each questionnaire. A major strength of this thesis is our multidisciplinary approach (multiple urologists, a professor with expertise in Learning and Instruction, and a professor with expertise in patient safety) to our research questions as we focus on training and skills assessment from different perspectives to provide a complete overview of the possible answers for the main questions of this thesis. The evaluation of surgical skills was performed either by use of a virtual reality simulator, which may provide objective measurements, or by video analysis with a more subjective assessment. We have tried to implement objective assessment methods of surgical video analysis in this thesis but technical limitations (because of a more close-up camera position for robotic surgery as compared to laparoscopic surgery, the speed of the surgical instruments, tissue overlapping the instrument, and the fact that the instrument has flexible joints) resulted in difficulties with automated assessment of surgical movements. The objective measurement of the urethral length was successful although the accuracy of method of measurement is dependent on the level of training of the assessor. All other in literature described methods for video analyses are more subjective methods of assessment since they required action (assessment of videos using assessment templates) by the researcher. None of the results of the templated assessment methods could be used to predict the patient’s postoperative outcome. Reason for this might be that the surgical procedures analysed were performed by one single surgeon who is an expert in the field of RAS and has performed over 2000
RkJQdWJsaXNoZXIy MTk4NDMw