***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: OBJECTIVES To compare intraoperative blood loss , perioperative hematocrit , and transfusion requirements in patients undergoing radical retropubic prostatectomy ( RRP ) versus robotic-assisted laparoscopic prostatectomy ( RALP ) by a single surgeon . METHODS During a 14-month period , 279 patients with localized carcinoma of the prostate were prospect ively enrolled in this comparative study . The decision of which surgical approach to use was by patient choice . Of the 279 patients , 176 underwent RALP and 103 underwent RRP . The serum hematocrit was obtained preoperatively and 24 hours postoperatively in all patients . The intraoperative blood loss was recorded , and transfusion requirements were noted . RESULTS Patients in the RALP group had significantly less intraoperative blood loss compared with the RRP group ( mean 191 mL versus 664 mL , P < 0.001 ) . Additionally , the difference in the discharge hematocrit ( 36.8 % versus 32.8 % , P < 0.001 ) and the mean perioperative change in hematocrit ( 8.0 % decrease versus 10.7 % decrease , P < 0.001 ) were significant between the RALP and RRP groups , respectively . Three patients in the RRP group ( 2.9 % ) and one in the RALP group ( 0.5 % ) required transfusion of blood products ( P = 0.14 ) . CONCLUSIONS The results of this study have shown that RALP is associated with less intraoperative bleeding than RRP , and patients undergoing RALP have a greater serum hematocrit at hospital discharge . The lack of a statistically significant difference in blood transfusion was partially attributable to the low transfusion rate in both groups in this series OBJECTIVES Robotic assistance may enhance the precision of anatomic dissection and increase the feasibility of performing laparoscopic radical prostatectomy for most surgeons . We performed a prospect i ve comparison of 30 consecutive patients undergoing conventional radical retropubic prostatectomy ( RRP ) and 30 initial patients undergoing robot-assisted anatomic prostatectomy ( RAP ) at our institution . METHODS The study design was a prospect i ve nonr and omized comparison of anatomic RRP performed using the technique of Walsh and RAP performed with the da Vinci surgical system . We evaluated the baseline patient and tumor characteristics ( age , body mass index , serum prostate-specific antigen , Gleason score , and clinical stage ) , intraoperative parameters ( operative time , blood loss , and need for transfusion ) , postoperative parameters ( pain score , hospitalization duration , catheter duration ) , histopathologic parameters , and complications in the two groups . RESULTS The preoperative parameters were comparable for both groups of patients . The mean setup time for RAP was 0.95 hours . The mean operating time was 2.3 hours for RRP and 4.8 hours for RAP ( P < 0.001 ) . One patient required conversion from RAP to RRP because of a lack of progress . The mean blood loss was 970 mL for RRP and 329 mL for RAP ( P < 0.001 ) . The drop in hemoglobin was greater in the RRP group ( 4.4 versus 1.2 g in RAP ; P < 0.05 ) . The mean pain score on postoperative day 1 was 7 in the RRP group and 4 in RAP group ( P = 0.05 ) . The mean hospital stay was 56 hours in the RRP group and 36 hours in the RAP group ( P value not significant ) . Sixty-three percent of the RAP and 0 % of the RRP groups were discharged within 23 hours ( P < 0.001 ) . The mean duration of postoperative catheterization was 14 days for the RRP and 11 days for the RAP groups ( difference not significant ) . The pathologic stage , margin status , and prostate-specific antigen values were not different between the two groups . The setup time , operative time , blood loss amount , and catheterization duration were significantly reduced after the first 20 patients . CONCLUSIONS Currently , RAP is a longer procedure than RRP . However , the blood loss is minimal and patients feel less pain and are discharged earlier from the hospital . In our h and s , the margin status and complication rates were comparable for both techniques PURPOSE We developed a preoperative nomogram for prediction of lymph node metastases in patients with clinical ly localized prostate cancer . MATERIAL S AND METHODS The study was a retrospective , nonr and omized analysis of 7,014 patients treated with radical prostatectomy at 6 institutions between 1985 and 2000 . Exclusion criteria consisted of preoperative and rogen ablation therapy , salvage radical prostatectomy and pretreatment prostate specific antigen ( PSA ) greater than 50 ng/ml . Preoperative predictors of lymph node metastases consisted of pretreatment PSA , clinical stage ( 1992 TNM ) and biopsy Gleason sum . These predictors were used in logistic regression analysis based nomograms to predict the probability of lymph node metastases . RESULTS Overall 5,510 patients with complete clinical and pathological information were included in the study .  Lymph nodes metastases were present in 206 patients ( 3.7 % ) . Pretreatment PSA , biopsy Gleason sum , clinical stage and institution represented predictors of lymph node status ( p < 0.001 ) . Bootstrap corrected predictive accuracy of the 3-variable nomogram ( clinical stage , Gleason sum and PSA ) was 0.76 . Inclusion of a fourth variable , which accounts for institutional differences in lymph node metastases , yielded an area under the receiver operating characteristics curve of 0.78 . The negative predictive value of our nomograms was 0.99 when they predicted 3 % or less chance of positive lymph nodes . CONCLUSIONS Using clinical information , we produced 2 calibrated and vali date d nomograms , which accurately predict pathologically negative lymph nodes in men with localized prostate cancer who are c and i date s for radical prostatectomy PURPOSE Minimally invasive surgery has been shown to decrease postoperative morbidity and length of stay for a number of surgical procedures . Furthermore , length of stay after open radical prostatectomy has decreased dramatically during the last decade . We examined differences in length of stay between a prospect ively evaluated cohort of patients who underwent radical retropubic prostatectomy and robot assisted laparoscopic prostatectomy .  MATERIAL S AND METHODS Between January 2003 and March 2006 , 1,003 radical prostatectomies were performed at our hospital . Data were collected in prospect i ve fashion and a comparison was made between 374 patients who underwent radical retropubic prostatectomy and 629 who underwent robot assisted laparoscopic prostatectomy .  Length of stay , factors influencing length of stay , readmission rates and unscheduled clinic or emergency room visits were evaluated . Patients in the 2 groups were treated using the same clinical care pathway . RESULTS Overall 94.3 % of patients in the radical retropubic prostatectomy group and 97.5 % in the robot assisted laparoscopic prostatectomy group were discharged home on or before postoperative day 1 . Mean length of stay in the radical retropubic and robot assisted laparoscopic prostatectomy groups was 1.25 ( median 1.09 ) and 1.17 days ( median 1.03 ) , which was similar and not statistically different ( p=0.27 ) . Readmission rates were similar in robot assisted laparoscopic and radical retropubic prostatectomy patients ( 7 % and 5 % , respectively , p=0.12 ) . Unscheduled clinic or emergency room visits were the same in the robot assisted laparoscopic and radical retropubic prostatectomy groups ( 10 % , p=0.95 ) . CONCLUSIONS Patients who underwent radical retropubic prostatectomy or robot assisted laparoscopic prostatectomy  can be treated on the same clinical pathway . A targeted hospital discharge date of postoperative day 1 can be achieved in the majority of patients who underwent radical prostatectomy . Readmission rates or unscheduled hospital visits are necessary in a small percent of patients treated with an early discharge program , of which the majority are caused by ileus Background : The best technique of radical prostatectomy - open versus robot-assisted approach - is controversially discussed . In this study , we compared the complication rates of open and robot-assisted radical prostatectomy during the introduction and subsequent routine use of a da Vinci ® robotic device while open surgery remained the st and ard approach . Patients and Methods : Between January 1st , 2006 , and June 4th , 2012 , 2,754 men underwent radical prostatectomy at our department . Among them , 317 received robot-assisted and 2,438 open surgery .  According to the requirements for prostate cancer centers certified by the Deutsche Krebsgesellschaft ( German Cancer Society ) , a prospect i ve data base recording perioperative complications was built up . The complication rates of open and robot-assisted radical prostatectomy were compared with the χ2 or Fisher exact test . The distributions of quantitative variables were compared with U tests . Results : Whereas the demographic factors favored patients selected for robot-assisted radical prostatectomy , there were no differences between open and robot-assisted surgery  concerning length of stay , autologous blood transfusion rates and the incidence of perioperative complications . Conclusions : Open and robot-assisted radical prostatectomy had comparable complication rates . With better patient- and tumor-related parameters as well as decreasing transfusion rates in the robot-assisted subgroup , this observation might reflect the learning curves of the involved robotic surgeons We prospect ively compared , within the same center and during the same period of time , the perioperative parameters as well as the oncological and functional results of both open retropubic ( ORP ) and laparoscopic radical prostatectomy ( LRP ) .  From September 1999 to September 2001 , 162 patients with prostate cancer were treated with radical prostatectomy , 77 using an open retropubic technique , and 85 by the laparoscopic extraperitoneal approach .  We prospect ively recorded pre- , per- and postoperative parameters and complications , and evaluated the carcinological and functional results , comparing both approaches . There were no significant differences in the preoperative characteristics of the two groups . Mean operative time was statistically longer with LRP than with ORP ( 288 vs 168 min , P<0.0001 ) but median blood loss was decreased ( 400 vs 1,300 ml , P<0.0001 ) . Major complications occurred in a similar number of cases ( 5 % vs 2.4 % , NS ) while minor complications occurred more frequently with ORP ( 24.6 vs 11.8 % , P=0.003 ) . Pathological examination revealed a similar distribution of Gleason scores and stages in each group . Positive surgical margins in pT2 cases occurred in 7.8 % of LRP and 7.3 % of ORP . Continence rates ( no pad and no leakage at all ) were similar ( 83.9 % in ORP vs 80.7 % in LRP , NS ) . Potency rates were similar after 1 year in patients undergoing bilateral nerve sparing ( 55 % in ORP vs 65 % in LRP , NS ) . However , patients operated by LRP had more spontaneous erections . We conclude that this prospect i ve , comparative study shows that LRP , when performed in specialized centers , gives oncological and functional results comparable to open surgery OBJECTIVE To compare morbidity in two groups of patients who underwent retropubic or laparoscopic radical prostatectomy in the same period . PATIENTS AND METHODS The clinical and pathological data obtained in 50 consecutive patients who underwent retropubic radical prostatectomy ( RRP ) from January 2001 to December 2001 were compared to those obtained in 71 consecutive patients who were treated in the same year by extraperitoneal laparoscopic radical prostatectomy ( LRP ) .  The two groups were comparable in terms of mean pre-operative PSA and biopsy Gleason score . The peri-operative data included operative time , intra-operative and post-operative transfusion rates , complication rates , hospitalization length , and duration of catheterization . The following pathological parameters were considered : Gleason score , pathological stage , and positive surgical margin rate . A comparative evaluation of continence recovery ( no pads and any leakage ) was made only in patients with follow-up longer than 12 months . RESULTS The two groups were comparable in terms of pathological stage and definitive Gleason score . Operating times were significantly shorter in RRP ( p<0.0001 ) . LRP patients showed higher autologous ( p<0.001 ) and eterologous transfusion ( p=0.03 ) . No significant difference was observed in terms of complication rates ( p=0.07 ) . The rectal injury rate was 2.8 % in the laparoscopic group . The mean post-operative hospital stay was 10.2+/-2 days in the surgery group and 7.2+/-3.4 days in the laparoscopy group ( p<0.001 ) . Catheterization time was 8.4+/-0.9 days in the surgery group and 8+/-2.8 days in the laparoscopy group ( p=0.27 ) . After 12 months , complete continence was achieved in 
    Output:
    
With regard to the perioperative outcome , LRP and RALP were more time-consuming than RRP , but blood loss , transfusion rates , catheterisation time , hospitalisation duration , and complication rates were the most optimal in the laparoscopic approaches .
With regard to the functional and oncological results , RALP was found to have the best outcomes .
Conclusion : Our study confirmed the well-known perioperative advantage of minimally invasive techniques ; however , available data were not sufficient to prove the superiority of any surgical approach in terms of functional and oncologic outcomes .
On the contrary , cost comparison clearly supports RRP