349 Summary Summary Healthcare is constantly moving towards the improvement of quality of care and safety for patients. In the Netherlands, increasing attention is being paid to the relocation of complex treatments such as different types of robot assisted surgery (RAS) to high-volume centres as it is expected to improve the quality of care and increases patient safety due to the increased exposure of surgeon and staff.1–4 The question remains whether the higher number of surgical procedures per hospital or the quality of the surgeon influences the patients outcome. There are large variations in postoperative complication rates amongst surgeon with similar surgical volumes per centre or even in the same centre.5,6 The qualification and certification of RAS skills are still in a preliminary phase within all surgical specialties, also in urology. The introduction of the surgical robot resulted in increasing technical difficulty of these robot assisted surgeries. New methods of training for novice surgeons (residents and fellows) in these highly specialised techniques should be implemented to guarantee patient safety.7 Where general guidelines and certification criteria have been set for laparoscopic surgery in the form of the European Basic Laparoscopic Urological Skills (E-BLUS) examination,8–10 no such guidelines exist for RAS. The challenge for novice surgeons is how to learn new surgical procedures and once the procedure is learned and they become experts how to analyse past performances and subsequently use this as a lesson for the future. The first part of the thesis focuses on the following research question: What are the best methods to educate surgeons in robotic surgery? In response to the introduction of RAS multiple organizations and physicians have called for the development of structured training and basic qualifications for surgeons.11–17 Although multiple structured training curricula have been developed14–16,18,19 currently no general criteria are set for starting RAS. If no structured training program or set of basic criteria are provided novice surgeons will design their own training program based on their own perceived lack of knowledge.20,21 The novices own perceived lack of knowledge and skills can be influenced by overconfidence biases, an over-assessment of skills which can results in a hiatus of training. To provide a guideline for the basic competence level needed to safely perform robotic surgery the ‘Basic proficiency requirements for the safe use of robotic surgery’ (BPR) was developed by the NIVEL.11 The results of a one-day training in basic RAS based on the BPR are presented in chapter 2. The training consisted of all important aspects of system training (containing different modality’s of training, i.e., hands-on training combined with theoretical
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