***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective To evaluate impact of unidirectional barbed suture on vesicourethral anastomosis ( VUA ) during robot-assisted radical prostatectomy ( RARP ) and its comparison with Polyglecaprone-25 suture . Patients and methods The study was initiated as pilot study ; the participants were grouped into three based on the suture material used for VUA , i.e. , monofilament Polyglecaprone-25 ( group 1 ) , unidirectional barbed Glycolic acid-trimethylene carbonate ( group 2 ) , and bidirectional barbed Polyglycolic acid-polycaprolactone ( group 3 ) , respectively . Group 1 was included retrospectively and the latter two prospect ively . All cases were operated upon by the same surgeon , proficient in RARP . Patient-demographics , intraoperative and peri-operative data were collected . Our technique of mucosa-to-mucosa VUA is carried out in a choreographed manner using unibarbed suture . Results Fifty-five patients were included ; 25 each in group 1 and 2 . The group 3 was prematurely closed after 5 cases due to perceived inappropriateness of needle characteristics of the suture material . Therefore , the statistical analysis was performed between group 1 and 2 only . Preoperative characteristics including age , PSA , clinical stage , and biopsy grade were similar between the groups . The anastomosis time was significantly less in group 2 ( 8.4 ± 1.7 min vs. 14.3 ± 4.8 min ; P = 0.0001 ; t test ) . Postoperative hospital stay was less in group 2 ( 2.7 ± 1.1 days vs. 1.9 ± 0.8 days ; P = 0.023 ; Mann – Whitney U ) . None of the patient had presented with urinary leaks , urinary retention , or anastomotic strictures at follow-up of 6 months . Conclusion VUA with unidirectional barbed suture is safe and takes less time compared to monofilament suture as repeated cinching ; help of assistance and knot tying are not required by virtue of its self-retaining characteristics 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 OBJECTIVE To compare perioperative and functional outcomes after urethrovesical anastomosis ( UVA ) with barbed polyglyconate and monofilament poliglecaprone in  robot-assisted radical prostatectomy ( RARP ) . Barbed polyglyconate suture was first used for the UVA during RARP beginning in January 2010 ; safety and feasibility were previously demonstrated in 51 patients . METHODS From May to September 2010 , 64 patients meeting all the inclusion criteria participated in the present multisurgeon prospect i ve , r and omized , controlled trial and underwent posterior repair and UVA during RARP with either barbed polyglyconate ( n=33 ) or monofilament poliglecaprone ( n=31 ) suture . The primary outcomes were the anastomotic ( UVA ) and posterior reconstruction times . Secondary outcomes included cystogram leak , bladder neck reconstruction rate , and 6-week functional outcomes assessed by a self-administered vali date d patient question naire . RESULTS Posterior reconstruction was performed within 3.3 minutes with the barbed suture versus 4.3 minutes with the monofilament poliglecaprone suture ( 23.3 % reduction ) and UVA within 10.1 versus 13.8 minutes , respectively ( 26.8 % reduction ) . The absolute time difference for the 2-layer anastomosis was 4.7 minutes ( a 26.0 % reduction in the total anastomosis time ) . All other perioperative outcomes were equivalent between the 2 groups . Urinary functional outcomes , including the pad use and leakage rates , were equivalent at 6 weeks . CONCLUSION Anastomosis during RARP with the V-Loc barbed suture can be performed safely and more efficiently than with st and ard monofilament suture . We demonstrated a 26 % decrease in the anastomotic time with no increase in the adverse events , no instances of urinary retention and equivalent functional outcomes were measured with the self-administered patient question naire BACKGROUND Perioperative complications following  robotic-assisted radical prostatectomy ( RARP )  have been previously reported in recent series . Few studies , however , have used st and ardized systems to classify surgical complications , and that inconsistency has hampered accurate comparisons between different series or surgical approaches . OBJECTIVE To assess trends in the incidence and to classify perioperative surgical complications following RARP in 2500 consecutive patients . DESIGN , SETTING , AND PARTICIPANTS We analyzed 2500 patients who underwent RARP for treatment of clinical ly localized prostate cancer ( PCa ) from August 2002 to February 2009 . Data were prospect ively collected in a customized data base and retrospectively analyzed . INTERVENTION All patients underwent RARP  performed by a single surgeon . MEASUREMENTS The data were collected prospect ively in a customized data base . Complications were classified using the Clavien grading system . To evaluate trends regarding complications and radiologic anastomotic leaks , we compared eight groups of 300 patients each , categorized according the surgeon 's experience ( number of cases ) . RESULTS AND LIMITATIONS Our median operative time was 90min ( interquartile range [ IQR ] : 75 - 100min ) . The median estimated blood loss was 100ml ( IQR:100 - 150ml ) . Our conversion rate was 0.08 % , comprising two procedures converted to st and ard laparoscopy due to robot malfunction . One hundred and forty complications were observed in 127 patients ( 5.08 % ) . The following percentages of patients presented grade d complications : grade 1 , 2.24 % ; grade 2 , 1.8 % ; grade 3a , 0.08 % ; grade 3b , 0.48 % ; grade 4a , 0.40 % . There were no cases of multiple organ dysfunction or death ( grade s 4b and 5 ) . There were significant decreases in the overall complication rates ( p=0.0034 ) and in the number of anastomotic leaks ( p<0.001 ) as the surgeon 's experience increased . CONCLUSIONS RARP is a safe option for treatment of clinical ly localized PCa , presenting low complication rates in experienced h and s. Although the robotic system provides the surgeon with enhanced vision and dexterity , proficiency is only accomplished with consistent surgical volume ; complication rates demonstrated a tendency to decrease as the surgeon 's experience increased BACKGROUND Transperitoneal robot-assisted laparoscopic prostatectomy ( RALP ) urethrovesical anastomosis is a critical step . Although the prevalence of urine leaks ranges from 4.5 % to 7.5 % at high-volume RALP centers , urine leaks prolong catheterization and may lead to ileus , peritonitis , and require intervention . Barbed polyglyconate sutures maintain running suture line tension and may be advantageous in RALP anastomosis for reducing this complication . OBJECTIVE To compare barbed polyglyconate and polyglactin 910 ( Vicryl , Ethicon , Somerville , NJ , USA ) running sutures for RALP anastomosis . DESIGN , SETTING , AND PARTICIPANTS This was a prospect i ve , r and omized , controlled , single-surgeon study comparing RALP anastomosis using either barbed polyglyconate ( n = 45 ) or polyglactin 910 ( n = 36 ) sutures . SURGICAL PROCEDURE RALP anastomosis using either barbed polyglyconate or polyglactin 910 sutures was studied . MEASUREMENTS Operative time , cost differential , perioperative complications , and cystogram contrast extravasation by anastomosis suture type were measured . RESULTS AND LIMITATIONS Although baseline characteristics and overall operative times were similar , barbed polyglyconate sutures were associated with shorter mean anastomosis times of 9.7 min versus 9.8 min ( p = 0.014 ) . In addition , anastomosis with barbed polyglyconate rather than polyglactin 910 sutures was associated with more frequent cystogram extravasation 8 d postoperatively ( 20.0 % vs 2.8 % ; p = 0.019 ) , longer mean catheterization times ( 11.1 d vs 8.3 d ; p = 0.048 ) , and greater suture costs per case ( $ 51.52 vs $ 8.44 ; p < 0.001 ) . After 8 of 29 ( 27.6 % ) barbed polyglyconate anastomosis sites demonstrated postoperative day 8 cystogram extravasation , we modified our technique to avoid overtightening , reducing cystogram extravasation to 1 ( 6.3 % ) of 16 subsequent barbed polyglyconate anastomosis sites . Potential limitations include small sample size and the single-surgeon study design . CONCLUSIONS Compared to traditional sutures , barbed polyglyconate is more costly and requires technical modification to avoid overtightening , delayed healing , and longer catheterization time following RALP OBJECTIVES The performance of the urethrovesical anastomosis is one of the most difficult steps in urologic laparoscopy . Many different techniques have been developed to improve this step and , recently , new sutures such as the V-loc ( R ) barbed system have been created . In the present study we analyze the usefulness of this suture for diminishing the time employed for the anastomosis suture during the learning curve of laparoscopic radical prostatectomy . METHOD We performed a prospect i ve comparative study between two groups . The first group included the first 50 cases of a novel surgeon using this barbed suture  , and we compared these procedures with 50 consecutives cases of an experienced surgeon . We compared preoperative parameters , surgical and suturing times , as well as drain and catheter duration , and hospital stay . RESULTS We did not find statistically significant differences in any pre or postoperative parameters between both groups . Although surgical time was lower in the control group this difference was not statistically significant . The time used to perform the suture was lower in the study group , and we found significant differences between both groups . Neither drain nor bladder catheter times were different between groups . CONCLUSIONS In the absence of prospect i ve r and omized trials comparing barbed or not barbed running sutures , our study shows that the use of the V-loc ® system improves the times needed for the urethrovesical anastomosis during the learning curve of laparoscopic radical prostatectomy BACKGROUND AND PURPOSE With widespread implementation of posterior rhabdosphincter reconstruction ( RSR ) followed by urethrovesical anastomosis ( UVA ) , reconstruction has become a significant portion of robot-assisted laparoscopic prostatectomy ( RALP ) . Successful anastomosis can be measured by time for reconstruction and the absence of urinary leak . We prospect ively evaluated the experience of a single sur 
    Output:
    
Our meta- analysis indicates that UBS appears to be safe and efficient as CS for UVA during RARP with not only shorter anastomosis time , operative time , PR time , but also equivalent PL rate , EBL , LOC , and continence rates at 4 - 6 weeks , 3 months and 6 - 12 months after surgery .