Alexander Beulens

195 A prospective observational multicentre study concerning non-technical skills in robot assisted radical cystectomy versus open radical cystectomy. nical Skills-assessment method will be used to assess non-technical skills. The surgical videos will be analysed using a customizable video analysis software “digital Video Coach” developed by ZEAL IT (figure 2). The video analysis software “Digital Video Coach” makes it possible to register the occurrence of Non-Technical Skills behaviour and peri-operative events (i.e. people entering or leaving the OR, phone calls, etc.) Two sets of labels will be created in order to define the different Non-Technical Skills behaviour and peri-operative events present during the surgery. The selection of one of the labels automatically marks the time code corresponding to the moment the label was pressed. This makes it possible to measure the duration of the Non-Technical Skills behaviour and peri-operative events. The labels used for this analysis will be Non-Technical Skills-assessment method specific. Training of the two observers (observer 1 and 2) will be performed using the NOTSS introductory course and advanced course (NOTSS for Trainees and NOTSS in a Box) as developed by the Royal College of Surgeons of Edinburgh.23 Further training in the remaining analysis methods will be performed by a specialist in Non-Technical Skills assessment (observer 3). The technical skills assessment training will be performed by an expert on technical skills analysis with expert knowledge of the procedure and Robot Assisted Surgery (observer 4, is a surgeon who has performed over 200 Open Radical Cystectomy and Robot Assisted Radical Cystectomy procedures and a trainer of new and experienced surgeons). Observer 4 will act as independent expert in case of disagreement between the two observers (observer 1 and 2). The videos will be recorded using three cameras installed in three different point in the OR. Objects which should be in view are: the OR table, in case of robot assisted surgery the robot console, the anaesthesiology equipment, the OR door to the non-sterile area of the OR complex, the OR door to the sterile area of the OR. Recording from three different angles in the OR will assure there will be a 360-degree view of the proceedings in the OR. The cameras used have a 170-degree image angle with high definition imaging so maximum coverage can be achieved. Voice data will be collected using personalized voice recorders per staff member present in the OR. The audio feed on the cameras is strong enough to get a general view of the conversations during the surgery, for detailed analysis the recording of personal voice recorder will be used to gain insight into the orders given during difficult of abnormal phases of the surgery. Surgeon specific data will be recorded at the start of the OR, these include but are