Alexander Beulens

189 A prospective observational multicentre study concerning non-technical skills in robot assisted radical cystectomy versus open radical cystectomy. Introduction and Hypotheses Qualification and certification of surgical skills performance are still in a preliminary phase within all surgical specialties, including urology. There are, however, urgent calls from the government and patient organizations for well-defined proficiency standards to safeguard the quality of care.1,2 Also, professionals themselves are increasingly interested to define their qualifications and to improve skills.3 Multiple research groups are investigating the relation between surgeons’ technical skills and postoperative outcome.4–6 With the introduction of laparoscopy and the surgical robot new and improved assessment tools of surgical skills have been developed.5,7–9 Although the analysis of technical surgical skills in robot assisted surgery can lead to major improvements of postoperative outcomes10, the possible influence of Non-Technical-Skills on postoperative outcomes also merits attention The Non-Technical Skills needed for a successful Robot Assisted Radical Cystectomy probably differ from the Non-Technical Skills needed for Open Radical Cystectomy. Even though several general assessment methods have been developed for both the entire team11–13 and individual team members14–16 the question remains if these tools can accurately assess Non-Technical Skills in such complex robot assisted surgeries as Robot Assisted Radical Cystectomy. With the introduction of the Interpersonal and Cognitive Assessment for Robotic Surgery (ICARS)17, adaptation to the robot assisted surgical setting has started. The introduction of the surgical robot has totally changed the traditional set-up of the operating room, since scrub nurse and surgeon are no longer on opposite sides of the patient. In robot assisted surgery the surgeon is located in a separate control console during most of the surgery, and therefore direct communication with the team members could be hampered. It is conceivable that loss of non-verbal communication can influence the work-flow and therefore the quality of the performance including patient’s safety. Two systematic reviews have been published concerning studies of Non-Technical Skills in minimal invasive surgery (i.e. conventional laparoscopy and robot assisted surgery).18,19 A wide variety in assessments of Non-Technical Skills was used which makes comparison of tools difficult.18,19 Van der Vliet et al.19 advises additional Non-Technical Skills research to be performed in the different surgical approaches (open, laparoscopic, robot-assisted) . Moreover,