***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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    ***EXAMPLES*** 
    Input: PURPOSE The aim of this study is to compare the perioperative outcomes after transumbilical laparoendoscopic single-site ( LESS ) radical nephrectomy ( LESS-RN ) performed by a surgeon during his learning curve of this novel procedure with the outcomes after st and ard laparoscopic radical nephrectomy ( LRN ) for patients with a solitary renal tumor . Using this information , we examined whether LESS exhibits any objective advantages over st and ard laparoscopy . PATIENTS AND METHODS Twenty patients who underwent LESS-RN for a solitary cT(1)N(0)M(0 ) renal mass ( group 1 ) were matched and compared with 33 patients who underwent st and ard LRN ( group 2 ) for tumors of similar sizes . Patient and surgical data , pathologic outcomes , and follow-up information , including patient responses regarding cosmetic satisfaction , were analyzed . RESULTS The minimum duration of follow-up was 6 months for both groups . Patients in group 1 had significantly ( P<0.05 ) quicker recoveries of bowel function , shorter postoperative analgesic time , and lower pain scores during their hospital stay . At the time of the last follow-up , all patients remained symptom free , and no evidence of recurrence was detected . Compared with that of st and ard LRN patients , LESS-RN patients exhibited better cosmetic satisfaction scores postoperatively at least to 6 months ( P=0.013 ) . CONCLUSIONS Transumbilical LESS-RN is a feasible , safe , and efficacious procedure with favorable perioperative outcomes that results in significantly improved control of postoperative pain , more rapid recovery of bowel function , and increased cosmetic satisfaction . Additional research , including r and omized controlled trials and long-term follow-ups , however , will be needed to draw solid conclusions regarding the relative efficacy of this procedure compared with st and ard approaches BACKGROUND AND PURPOSE Laparoendoscopic single-site ( LESS ) surgery through the retroperitoneal approach has been seldom reported . We aim ed to compare the feasibility and outcomes of LESS and conventional laparoscopic surgery via the retroperitoneal approach in the management of large , impacted ureteral stones . PATIENTS AND METHODS From June 2010 to May 2011 , LESS ureterolithotomy through the retroperitoneal approach was performed in 10 patients ( the LESS group ) . Another 15 patients who underwent conventional retroperitoneal laparoscopic ureterolithotomy ( the conventional laparoscopic group ) by the same surgeon were involved and compared . The operative time , complications , and surgical outcomes were evaluated . RESULTS All the operations were completed successfully , without conversion to conventional laparoscopic or open surgeries . The operative time of the LESS group and of the conventional laparoscopic group were 132.7±16.3 and 128.1±20.1 minutes , respectively ( P=0.782 ) . The estimated blood loss were 30.7±5.9 vs 28.0±4.5 mL ( P=0.620 ) . Duration of analgesia postoperatively was 2.0±0.8 vs 3.5±0.5 days ( P=0.005 ) . All targeted stones were successfully extracted without major complications . Postoperative urine leakage was noted in one patient in each group . Cosmetic results were superior in the LESS group according to both the study nurse 's and the patients ' assessment s ( 8.5 vs 5.3 ; P=0.012 , and 8.3 vs 5.6 ; P=0.025 , respectively ) . All patients showed no obstructions or stricture formations on postoperative follow-up . CONCLUSIONS In experienced h and s , LESS for ureterolithotomy through the retroperitoneal approach is feasible and can acquire outcomes equal to those of conventional multiport laparoscopic surgery . Prospect i ve long-term follow-up studies with a larger number of patients are needed to further evaluate its benefits Purpose : We report the outcomes of a r and omized clinical trial of single-port laparoscopic cholecystectomy ( SPLC ) and multiport laparoscopic cholecystectomy ( MPLC ) . Methods : Fifty-four patients ( 27 in each group ) were r and omized . A visual analog scale was used with a 10-point scale for an objective assessment of incisional pain and incisional cosmesis on postoperative days 1 , 3 , and 14 . Results : The mean operating time was significantly longer in the SPLC . The mean cosmesis scores on postoperative days 3 ( 9.7 vs. 8.9 , P=0.01 ) and 14 ( 9.9 vs. 9.2 , P<0.01 ) were significantly greater in the SPLC group than in the MPLC group . The group ’s mean visual analog scale scores for incisional pain , and their requirements for analgesics , did not differ significantly . Conclusions : Although SPLC takes longer than MPLC , experienced laparoscopic surgeons can perform SPLC safely with results comparable with those for MPLC . SPLC is superior to MPLC in terms of short-term cosmetic outcomes BACKGROUND In recent years , new devices providing multiple channels have made the performance of laparoscopic cholecystectomy through a single access site not only feasible but much easier . The potential benefits of laparoendoscopic single-site ( LESS ) cholecystectomy may include scarless surgery , reduced postoperative pain , reduced postoperative length of stay , and improved postoperative quality of life . There are no comparative data between LESS cholecystectomy and st and ard laparoscopic cholecystectomy ( LC ) available at present with which to quantify these benefits . METHODS This study was a prospect i ve , r and omized , dual-institutional pilot trial comparing LESS cholecystectomy with st and ard LC . The primary end point was postoperative quality of life , measured as length of hospital stay , postoperative pain , cosmetic results , and SF-36 question naire scores . Secondary end points included operative time , conversion to st and ard LC , difficulty of exposure , difficulty of dissection , and complication rate . RESULTS No significant differences in postoperative lengths of stay were found in the two groups . Postoperative pain evaluation using a visual analogue scale showed significantly better outcomes in the st and ard LC arm on the same day of surgery ( P = .041 ) . No differences in postoperative pain were found at the next visual analogue scale evaluation or in the postoperative administration of pain-relieving medications . Cosmetic satisfaction was significantly higher in the LESS group at 1-month follow-up ( mean , 94.5 ± 9.4 % vs 86 ± 22.3 % ; median , 100 % vs 90 % ; P = .025 ) . Among the 8 scales of the SF-36 assessing patients ' physical and mental health , scores on the Role Emotional scale were significantly better in the LESS group ( mean , 80.05 ± 29.42 vs 68.33 ± 25.31 ; median , 100 vs 66.67 ; P < .0001 ) . CONCLUSIONS In this pilot trial , LESS cholecystectomy result ed in similar lengths of stay and improved cosmetic results and SF-36 Role Emotional scores but performed less well on pain immediately after surgery . A larger multicenter trial is needed to confirm and further investigate these results BACKGROUND This study aim ed to compare the outcomes of single-incision laparoscopic cholecystectomy ( SILC ) versus conventional 4-port laparoscopic cholecystectomy ( LC ) . METHODS From November 2009 to August 2010 , 51 patients with symptomatic gallstone or gallbladder polyps were r and omized to SILC ( n = 24 ) or 4-port LC ( n = 27 ) . RESULTS Mean surgical time ( 43.5 vs 46.5 min ) , median blood loss ( 1 vs 1 mL ) and mean hospital stay ( 1.5 vs 1.8 d ) were similar for both the SILC and 4-port LC group . There were no open conversions and no major complications . The mean total wound length of the SILC group was significantly shorter ( 1.76 vs 2.25 cm ) . The median visual analogue pain score at 6 hours after surgery was similar ( 4.5 vs 4.0 ) but the SILC group had a significantly worse pain score on day 7 ( 1 vs 0 ) . There was no difference in time to resume usual activity ( mean , 5.6 vs 5.0 d ) . The median cosmetic score of SILC was significantly higher than at 3 months after surgery ( 7 vs 6 ) . CONCLUSIONS SILC was feasible and safe for properly selected patients in experienced h and OBJECTIVE To determine whether laparo-endoscopic single-site surgery ( LESS ) results in less postoperative pain and a better cosmetic surgical scar compared with conventional laparoscopy . DESIGN Prospect i ve r and omized controlled trial . SETTING A county hospital in Norway . PATIENT(S ) Forty women with benign adnexal disease or a hereditary cancer risk scheduled for laparoscopic adnexal surgery . INTERVENTION(S ) LESS or conventional laparoscopy . MAIN OUTCOME MEASURE(S ) Postoperative pain 24 hours after surgery . RESULT ( S ) There was no difference in pain at 24 hours after surgery , with a mean score of 3.0 ( SD 2.1 ) in the LESS group and 2.5 ( SD 1.5 ) in the conventional laparoscopy group . Significantly more shoulder tip pain was reported by women undergoing LESS compared with those having conventional surgery at 6 and 24 hours after surgery . A high satisfaction with the cosmetic result was reported in both groups , with no significant difference in the Manchester scar scale score . CONCLUSION ( S ) Although similar levels of postoperative pain are experienced by women having LESS and conventional laparoscopic surgery , women having LESS report significantly more shoulder tip pain compared to those having conventional laparoscopic surgery . This may relate to a significantly longer operation time in the LESS group . CLINICAL TRIAL REGISTRATION NUMBER NCT01288599 INTRODUCTION Use of laparoscopic surgery has dem and ed principles of less trauma of access hence less scar and so probably less complications . Hence conventional laparoscopic surgeries were tried with natural orifice transluminal surgery ( NOTES ) and then single incision laparoscopic surgery ( SILS ) . With refinement in instruments and surgeons skills SILS have bridged up between conventional and NOTES in order to quench the desire of less or no scar at all . METHODS Comparative case control study between conventional laparoscopic cholecystectomy and SILS in public teaching hospital . RESULTS Total 20 patients underwent SILS cholecystectomy and 20 underwent conventional cholecystectomy  and found that no difference between both in terms of post operative pain score , hospital stay and post operative wound infection except significant difference in mean operative time and patient 's level of satisfaction was less in patient with SILC if were subjected to pay for instruments in order to maintain cosmesis . CONCLUSIONS Though SILS have gained rapid acceptance in surgical fraternity , large number of r and omized controlled trials are necessary to show its benefit over conventional laparoscopic cholecystectomy Objective : The aim of the current study was to perform a multicentered prospect i ve double-blinded r and omized controlled trial comparing laparoendoscopic single-site access ( LESS ) versus conventional three-port laparoscopic appendectomy ( TPLA ) . Background : The clinical benefits and disadvantages of LESS appendectomy are uncertain . Methods : Between October 2009 and March 2011 , consecutive patients admitted with clinical or radiological evidence of appendicitis were r and omly assigned to receive either LESS or TPLA . The main outcome measurement was overall pain score . Secondary outcome measurements included operative time , conversion rates , morbidity rates , activity pain scores , activity scores , patient satisfaction , and cosmesis scores . Results : During the study period , 200 patients were recruited to the study . There were no significant differences in the morbidity rates , operative time , conversion rates , and postoperative recovery . There were also no differences in the overall pain score and pain score at rest . However , patients in the LESS group experienced significantly more pain upon coughing or st and ing and required more intravenous analgesics ( P = 0.001 , 0.038 , and 0.035 , respectively ) . Wound cosmesis and satisfaction scores on the contrary were better in the LESS group ( P = 0.002 and P = 0.052 ) . No differences in the quality -of-life assessment s were present at 2 weeks after operation . Conclusions : LESS and conventional appendectomy result ed in similar perioperative outcomes . However , LESS appendectomy result ed in worst pain scores upon exertion and required a higher dosage of intravenous analgesics when compared with TPLA . On the contrary , wound cosmesis and satisfaction scores were better in the LESS group . Hence , adoption of the technique for appendectomy will depend on patient preferences and the presence of local expertise Background Minimally invasive techniques have become an integral part of general surgery , with recent investigation into single-incision laparoscopic cholecystectomy ( SILC ) . This study presents a prospect i ve , r and omized , multicenter , single-blind trial of SILC compared with four-port cholecystectomy ( 4PLC ) with the goal of assessing safety , feasibility , and factors predicting outcomes . Methods Patients with biliary 
    Output:
    
This systematic review and meta- analysis demonstrates that there is a cosmetic advantage of the technique regardless of the operation type .