Alexander Beulens

89 Training novice robot surgeons: Proctoring provides same results as simulator-generated guidance line with the findings of Meier et al.20 Strengths and limitations The current study is a prospective randomised non-blinded randomized control trail. The partici-pants were aware on the existence of other study groups. However, they were not aware on the details of the other study groups. One of the challenges of this study was the inclusion of partici-pants, even though there are enough interns, PhDs and residents in the vicinity of the study loca-tion, it seems the subject of the study or the duration of the training (2 hours) had a deterring ef-fect on the participants. After multiple reminders the required number of participants was includ-ed. The randomization was performed using a simple randomization, prior to the start of the study. The trainers who have been training the participants from the proctor guided group, were not ex-pert robotic surgeons. They were researches who received a specific training including intensive simulation and extensive surgical procedures video watching. However due to the high time in-vestment (23 times 2 hours) it was not possible to use expert robotic surgeons as proctor in this study. The duration of the training was 2 hours, breaks were not included. This could have resulted in an excessive tiredness of the participants with a negative impact on the performance. At the same time the inclusion of breaks could have had a negative impact (distributed practice) on train-ees in particular between the intervention and post-intervention phase training 19,21 To our knowledge, in literature there are no data regarding the tiredness of surgeons during laparoscopic surgery22,23 and similar studies have not been performed either for RAS. The sample size was based on a publication of Sung Shim et al.3 They compared different types of simulation (independent learning, proctoring, and video guided learning) used during a training session focused on the performance of the vesicourethral anastomosis. The main outcome of the study was the time to complete the task and when comparing it with the results from Harri-son et al.21 it is noticeable that they are significantly different (253.47 vs. 2055.83 seconds). Based on this difference, we choose to use a fixed duration for the performance of the vesicourethral anastomosis. Based on the results of Harrison et al. a maximum time of 30 minutes per repetition is an acceptable timing to perform a vesicourethral anastomosis