Alexander Beulens

15 Introduction and Outline of the Thesis developed to investigate the link between surgeons’ skills in the RARP as assessed on video and post-operative adverse outcomes. Other research has shown that it is possible to relate surgical skills in general to post-operative adverse outcomes.7,40,42 Little research has been done to evaluate the skills of robot surgeons and define which parts of the intervention could be related to adverse outcomes, post-operative complications, erectly dysfunction, incontinence and lower urinary tract symptoms. A recent study into the combination of video data with the movement of the surgical robot with the dVlogger system led to greater insight into the performance of the surgeons and could accurately identify novices and experts.8 These types of surgical skills analysis could increase our understanding of the origins of complications and help to investigate whether the differences in surgical skills influence postoperative outcome. Non-technical skills analysis Although the analysis of technical surgical skills in robot assisted surgery can lead to major improvements of postoperative outcomes40, the possible influence of Non-Technical-Skills (NTS) on postoperative outcomes also merits attention. The NTS needed for a successful robot assisted surgery probably differ from the NTS needed for open surgery. The introduction of the surgical robot has profoundly altered the traditional set-up of the operating room, since the scrub nurse and the surgeon are no longer on opposite sides of the patient. In robot assisted surgery, the surgeon is located in a separate control console for most of the surgical procedure, and thus direct communication with the team members could be hampered. It is conceivable that loss of non-verbal communication can influence the workflow and therefore the quality of the performance including patients’ safety. Two systematic reviews have been published concerning studies of NTS in minimal invasive surgery (i.e. conventional laparoscopy and robot assisted surgery).43,44 A wide variety in assessments of NTS was used which makes comparison of tools difficult.43,44 Even though several general assessment methods have been developed for both the entire team45–47 and individual team members48–50 the question remains whether these