{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T07:39:26Z","timestamp":1792568366065,"version":"4.5.0"},"reference-count":26,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:00:00Z","timestamp":1792454400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:00:00Z","timestamp":1792454400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the association between objectively assessed intraoperative surgical performance and postoperative functional outcomes following robot\u2010assisted radical prostatectomy (RARP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients\/Subjects and Methods<\/jats:title>\n                    <jats:p>Prospectively collected data from 100 patients undergoing bilateral nerve\u2010sparing RARP by seven experienced robotic surgeons were analysed. To control for age\u2010related confounding, a subgroup of 66 subjects was selected from the initial cohort using age\u2010matching. These patients, all of whom were preoperatively potent, were identified from an audited outcomes registry with complete video recordings. In all, 14 trained surgeons trained to score the recordings using validated RARP\u2010specific metrics for procedure steps, errors, critical errors, and nerve\u2010sparing phase errors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      There were no significant pre\u2010 or postoperative differences in demographic or clinical variables between patients with good or poor outcomes. The mean inter\u2010rater reliability of video assessments was high (0.91). There were no significant differences in the number of steps completed or critical errors made. Intraoperative performance in cases resulting in erectile dysfunction at 12\u2009months was characterised by 43% more total errors and 67% more neurovascular bundle (NVB) dissection errors (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001) compared to cases with good functional outcomes. Age\u2010matched analysis confirmed differences of 31\u201354% (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). The number of intraoperative errors, particularly during NVB dissection, was strongly associated with clinical outcomes (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.01\u20130.008).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The objectively assessed intraoperative performance of the surgeon strongly predicted the clinical outcome of the procedure at 1\u2009year. The more errors the surgeon made the more likely the patient was to have erectile dysfunction at 12\u2009months.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bju.70503","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T06:48:33Z","timestamp":1792565313000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Intraoperative performance errors predict patient outcomes in robot\u2010assisted radical prostatectomy"],"prefix":"10.1111","author":[{"given":"Markus","family":"Graefen","sequence":"first","affiliation":[{"name":"Martini\u2010Klinik Prostate Cancer Center at the University Medical Center Hamburg\u2010Eppendorf  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Wiklund","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine and Surgery Section of Urology Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2190-3786","authenticated-orcid":false,"given":"Claudio","family":"Brancelli","sequence":"additional","affiliation":[{"name":"ORSI Academy  Melle Belgium"},{"name":"Department of Urology OLV  Aalst Belgium"},{"name":"Department of Urology, Azienda Ospedaliera Universitaria Integrata University of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brendan P.","family":"Bunting","sequence":"additional","affiliation":[{"name":"School of Psychology Ulster University  Derry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Breda","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3 Puigvert, Uro\u2010Oncology Unit and Kidney Transplant Surgical Program  Barcelona Spain"},{"name":"ERUS\u2010EAU  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niki","family":"Rashidian","sequence":"additional","affiliation":[{"name":"ORSI Academy  Melle Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1209-2956","authenticated-orcid":false,"given":"Edoardo","family":"Beatrici","sequence":"additional","affiliation":[{"name":"ORSI Academy  Melle Belgium"},{"name":"Department of Urology OLV  Aalst Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4081-8221","authenticated-orcid":false,"given":"Ruben","family":"De Groote","sequence":"additional","affiliation":[{"name":"ORSI Academy  Melle Belgium"},{"name":"Department of Urology OLV  Aalst Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1286-1399","authenticated-orcid":false,"given":"Rui","family":"Farinha","sequence":"additional","affiliation":[{"name":"Department of Urology Hospital da Luz  Lisbon Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne Sophie","family":"Knipper","sequence":"additional","affiliation":[{"name":"Vivantes Klinikum Am Urban  Berlin\u2010Kreuzberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Peraire","family":"Lores","sequence":"additional","affiliation":[{"name":"Urology Department Joan XXIII University Hospital  Tarragona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1597-9595","authenticated-orcid":false,"given":"Stefano","family":"Puliatti","sequence":"additional","affiliation":[{"name":"Department of Urology University of Modena and Reggio Emilia  Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Amato","sequence":"additional","affiliation":[{"name":"Department of Urology University of Modena and Reggio Emilia  Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8513-4985","authenticated-orcid":false,"given":"Camille","family":"Berquin","sequence":"additional","affiliation":[{"name":"Urology Department University of Gent  Ghent Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burkhard","family":"Beyer","sequence":"additional","affiliation":[{"name":"Kliniken Hartenstein  Bad Wildungen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6412-9546","authenticated-orcid":false,"given":"Carlo Andrea","family":"Bravi","sequence":"additional","affiliation":[{"name":"ORSI Academy  Melle Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Hohenhorst","sequence":"additional","affiliation":[{"name":"Martini\u2010Klinik Prostate Cancer Center at the University Medical Center Hamburg\u2010Eppendorf  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elio","family":"Mazzone","sequence":"additional","affiliation":[{"name":"Asst Grande Ospedale Metropolitano Niguarda  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8456-6495","authenticated-orcid":false,"given":"Marco","family":"Paciotti","sequence":"additional","affiliation":[{"name":"Humanitas University  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Artur","family":"Paludo","sequence":"additional","affiliation":[{"name":"Uro\u2010Oncology and Robotics Hospital Moinhos de Vento  Porto Alegre Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Piazza","sequence":"additional","affiliation":[{"name":"Urology, IRCCS Policlinico di Sant'Orsola  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Sarchi","sequence":"additional","affiliation":[{"name":"ORSI Academy  Melle Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0887-5613","authenticated-orcid":false,"given":"Anthony G.","family":"Gallagher","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, KU Leuven  Leuven Belgium"},{"name":"Faculty of Life and Health Sciences School of Medicine, Ulster University  Londonderry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre","family":"Mottrie","sequence":"additional","affiliation":[{"name":"ORSI Academy  Melle Belgium"},{"name":"Department of Urology OLV  Aalst Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,20]]},"reference":[{"key":"e_1_2_10_2_1","article-title":"Prostate cancer incidence and mortality: global status and temporal trends in 89 countries from 2000 to 2019","volume":"10","author":"Wang L","year":"2022","journal-title":"Front Public Health"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(17)38512-9"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa1300625"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2020.1004"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2168.1997.02502.x"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-2197.2012.06236.x"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-003-0035-4"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/bju.15311"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2012.05.046"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000151982.85062.80"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/bju.16170"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000004650"},{"key":"e_1_2_10_14_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2017-020099","article-title":"Proficiency\u2010based progression training: an \u2018end to end\u2019 model for decreasing error applied to achievement of effective epidural analgesia during labour: a randomised control study","volume":"8","author":"Srinivasan KK","year":"2018","journal-title":"BMJ Open"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0231979"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.0542"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2021.4414"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.13572"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-200210000-00008"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2022.05.056"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2015.07.001"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjstel-2015-000090"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/openhrt-2021-001629"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/bjsopen\/zrac041"},{"key":"e_1_2_10_25_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-025992","article-title":"Effect of proficiency based progression simulation training and standard simulation training on ISBAR performance. A randomized controlled trial","volume":"2019","author":"Breen D","year":"2019","journal-title":"BMJ Open"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1037\/0033-295X.100.3.363"},{"key":"e_1_2_10_27_1","volume-title":"Fundamentals of Surgical Simulation; Principles & Practices","author":"Gallagher AG","year":"2011"}],"container-title":["BJU International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/bjui-journals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/bju.70503","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/bjui-journals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/bju.70503","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/bjui-journals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/bju.70503","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T06:48:35Z","timestamp":1792565315000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjui-journals.onlinelibrary.wiley.com\/doi\/10.1111\/bju.70503"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,20]]},"references-count":26,"alternative-id":["10.1111\/bju.70503"],"URL":"https:\/\/doi.org\/10.1111\/bju.70503","archive":["Portico"],"relation":{},"ISSN":["1464-4096","1464-410X"],"issn-type":[{"value":"1464-4096","type":"print"},{"value":"1464-410X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,20]]},"assertion":[{"value":"2026-10-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"bju.70503"}}