***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: STUDY OBJECTIVE To compare the clinical and oncologic outcomes of Robotic radical hysterectomy ( RRH ) vs Laparoscopic radical hysterectomy ( TLRH ) in patients with cervical carcinoma . DESIGN Long term follow-up in a prospect i ve study between March 2010 to March 2016 . SETTING Oncological referral center , department of gynecology and obstetrics of Aless and ro Manzoni Hospital , department of gynecology , University of San Gerardo Monza , Milan . PATIENTS 52 patients with cervical carcinoma , matched by age , body mass index , tumor size , International Federation of Gynecology and Obstetrics ( FIGO ) stage , comorbidity , previous neoadjuvant chemotherapy , histology type , and tumor grade to obtain homogeneous sample s. INTERVENTIONS Patients with FIGO stage IA2 or IB1 with a tumor size less than or equal to 2 cm  underwent RR type B. RR-Type C1 was performed in stage IB1 , with a tumor size larger than 2 cm , or in patients previously treated with NACT ( IB2 ) . In all cases Pelvic lymphadenectomy was performed for the treatment of cervical cancer . MEASUREMENTS AND MAIN RESULTS Surgical time was similar for both the 2 groups . RRH was associated with significantly less ( EBL ) estimated blood loss ( P=0,000 ) . Median number pelvic lymph nodes was similar , but a major number of nodes was observed in RRH group ( 35.58 vs 24.23 ; P=0,050 ) . The overall median length of follow-up was 59 months ( range : 9 - 92 ) and 30 months ( range : 90 - 6 ) for RRH and TLRH group respectively . Overall survival rate ( OSR ) was 100 % for RRH group and 83.4 % for LTRH group . The DFS ( disease free survival rate ) was of 97 % and 89 % in RRH and LTRH group respectively . No significant difference was reported in HS ( hospital stay ) . CONCLUSIONS RRH is safe and feasible and is associated with an improved intraoperative results and clinical oncological outcomes . The present study showed that robotic surgery , in comparison to laparoscopic approach , was associated with better perioperative outcomes because of a decrease of EBL , and similar operative time , HS and complication rate , without neglecting the long-term optimal oncologic outcomes Objective The primary aim is to evaluate the surgical and oncological outcome of robotic radical hysterectomy ( RRH ) plus pelvic lymphadenectomy in locally advanced cervical cancer ( LACC ) after neoadjuvant chemotherapy ( NACT ) . The secondary aim is to compare the surgical and oncological results of RRH after NACT with a historical cohort of patients undergoing laparoscopic radical hysterectomy or abdominal radical hysterectomy plus pelvic lymphadenectomy for LACC after NACT . Methods We enrolled a total of 41 patients in this study with LACC undergoing RRH , who achieved a clinical partial or complete response to NACT .  The surgical and oncological outcomes of 2 historical groups were compared : the  laparoscopic group ( 41 patients ) with the  laparotomic group ( 43 patients ) . Results The median estimated blood loss , operative time , and length of hospital stay were statistically significant and in favor of the robotic group . No conversion to laparotomy in the robotic group was necessary . There were no significant differences between the 3-year overall survival and disease-free survival rates in the minimally invasive groups ; nevertheless , the robotic group showed the same recurrence rate of laparoscopic in a short-interval follow-up . Conclusions The robotic approach could be considered a feasible and safe alternative to other surgical options . Multicenter r and omized clinical trials with longer follow-ups are necessary to evaluate the overall oncologic outcomes of this procedure OBJECTIVE Robotic surgery , with its technical advances , promises to open a new window to minimally invasive surgery in gynaecology . Feasibility and safety of this surgical innovation have been demonstrated in several studies , and now a critical analysis of these new developments regarding outcome and costs is in place . So far only a few studies compare robotic with conventional laparoscopic surgery in gynaecology . Our objective was to evaluate our initial experience performing total robot-assisted hysterectomy  with the da Vinci surgical system and compare peri-operative outcome and costs with total laparoscopic hysterectomy . STUDY DESIGN For this prospect i ve matched case-control study at our institution , peri-operative data from our first 40 consecutive total robot-assisted hysterectomies for benign indications were recorded and matched 1:1 with  total laparoscopic hysterectomies according to age , BMI and uterus weight . Surgical costs were calculated for both procedures . Surgeons ' subjective impressions of robotics were evaluated with a self-developed question naire . RESULTS No conversions to laparotomy or severe peri-operative complications occurred . Mean operating time was 109 ( 113 ; 50 - 170 ) min for the robotic group and 83 ( 80 ; 55 - 165 ) min for the conventional laparoscopic group . Mean postoperative hospitalisation for robotic surgery was 3.3 ( 3 ; 2 - 6 ) days versus 3.9 ( 4 ; 2 - 7 ) days for the conventional laparoscopic group . Average surgical cost of a robot-assisted laparoscopic hysterectomy was 4067 euros compared to 2151 euros for the conventional laparoscopic procedure at our institution . For the robotic group wider range of motion of the instruments and better ergonomics were considered to be an advantage , and lack of direct access to the patient was stated as a disadvantage . CONCLUSION Robot-assited hysterectomy is a feasible and interesting new technique with comparable outcome to total laparoscopic hysterectomy . Operating times of total laparoscopic hysterectomy seem to be achieved quickly especially for experienced laparoscopic surgeons . However , costs of robotic surgery are still higher than for conventional laparoscopy . R and omised clinical trials need to be conducted to further evaluate benefits of this new technology for patients and surgeons and analyse its cost-effectiveness in gynaecology Background Recently , as a complex integrating a number of modern high-tech means , robotic surgery system is a well-deserved revolutionary tool in globally minimally invasive surgical field . For the first time in China , the objective of this study was to evaluate the efficacy and safety outcomes of robotic radical hysterectomy ( RRH ) in Chinese older women with cervical cancer compared with laparoscopic radical hysterectomy ( LRH ) . Methods In this prospect i ve , r and omized and double-blinded study , 60 Chinese older women with cervical cancer were evenly divided to accept the RRH or LRH . Follow-up period lasted for 24 months . Results Median age for the entire cohort was 65 ( range : 61 - 69 ) years . There was no difference in International Federation of Gynecology and Obstetrics ( FIGO ) stages and cell types between two groups ( p > 0.05 for all ) . Uterine size , tumor size , vaginal length and numbers of left and right pelvic lymph nodes did not differ between two groups ( p > 0.05 for all ) . No difference was observed in numbers of left and right lymph node metastasis ( p > 0.05 for all ) . All patients had negative margins without conversion to laparotomy . There were significantly less postoperative complications in the RRH group than in the LRH group ( p < 0.05 ) . Shorter indwelling time of bladder and drain catheters was observed in the RRH group than in the LRH group ( p < 0.05 for all ) . Length of postoperative hospital stay in the RRH group was significantly shorter compared with that in the LRH group ( p < 0.05 ) . Patients in two groups similarly experienced the recurrence and death ( p > 0.05 for all ) . Conclusions This study demonstrated that RRH provided additional benefits for Chinese older women with cervical cancer because of less complications and faster recovery compared with LRH . Meanwhile , this study supported an equivalence of surgical qualities and survival outcomes of RRH to LRH . Robotics-assisted surgical method is effective , safe and feasible for Chinese older women with cervical cancer Background . Robotic surgery in gynaecological oncology is a rapidly developing field as it offers several technical advantages over conventional laparoscopy . An audit was performed on the outcome of robotic surgery during our learning curve and compared with recent well-established laparoscopic procedure data . Method . Following acquisition of the da Vinci Surgical System ( Intuitive Surgical , Inc. , Sunnyvale , California , USA ) , we prospect ively analysed all cases performed over the first six months by one experienced gynaecologist who had been appropriately trained and mentored .  Data on age , BMI , pathology , surgery type , blood loss , morbidity , return to theatre , hospital stay , and readmission rate were collected and compared with a consecutive series over the preceding 6 months performed laparoscopically by the same team . Results . A comparison of two consecutive series was made . The mean age was somewhat different , 55 years in the robotic versus 69 years in the laparoscopic group , but obesity was a feature of both groups with a mean of BMI 29.3 versus 28.06 , respectively . This difference was not statistically significant ( P = 0.54 ) . Three subgroups of minimal access surgical procedures were performed : total hysterectomy and bilateral salpingooophorectomy ( TH + BSO ) , total hysterectomy and bilateral salpingooophorectomy plus bilateral pelvic lymphadenectomy ( TH + BSO + BPLND ) , and radical hysterectomy plus bilateral pelvic lymphadenectomy ( RH + BPLND ) . The mean time taken to perform surgery for TH + BSO was longer in the robotic group , 151.2 min compared to 126.3 min in the laparoscopic group . TH + BSO + BPLND surgical time was similar to 178.3 min in robotic group and 176.5 min in laparoscopic group . RH + BPLND surgical time was similar , 263.6 min ( robotic arm ) and 264.0 min ( laparoscopic arm ) . However , the numbers in this initial analysis were small especially in the last two subgroups and do not allow for statistical analysis . The rate of complications necessitating intervention ( Clavien-Dindo classification grade 2/3 ) was higher in the robotic arm ( 22.7 % ) compared to the laparoscopic approach ( 4.5 % ) . The readmission rate was higher in the robotic group ( 18.2 % ) compared to the laparoscopic group ( 4.5 % ) . The return to theatre in the robotic group was 18.2 % and 4.5 % in laparoscopic group . Uncomplicated robotic surgery hospital stay appeared to be shorter , 1.3 days compared to the uncomplicated laparoscopic group , 2.5 days . There was no conversion to the open procedure in either arm . Estimated blood loss in all cases was less than 100 mL in both groups . Conclusion . Robotic surgery is comparable to laparoscopic surgery in blood loss ; however , the hospital stay in uncomplicated cases appears to be longer in the laparoscopic arm . Surgical robotic time is equivalent to laparoscopic in complex cases but may be longer in cases not requiring lymph node dissection . The robotic surgery team learning curve may be associated with higher rate of morbidity . Further research on the benefits to the surgeon is needed to clarify the whole picture of this versatile novel surgical approach Background and Objectives : To compare intraoperative , pathologic and postoperative outcomes of robotic radical hysterectomy ( RRH ) to total laparoscopic radical hysterectomy ( TLRH )  in patients with early stage cervical carcinoma . Methods : We prospect ively analyzed cases of  TLRH or RRH with pelvic lymphadenectomy performed for treatment of early cervical cancer between 2000 and 2008 . Results : Thirty patients underwent TLRH and pelvic lymph-adenectomy for cervical cancer from August 2000 to June 2006 . Thirteen patients underwent RRH and pelvic lymph-adenectomy for cervical cancer from April 2006 to January 2008 . There were no differences between groups for age , tumor histology , stage , lymphovascular space involvement or nodal status . No statistical differences were observed regarding operative time ( 323 vs 318 min ) , estimated blood loss ( 157 vs 200 mL ) , or hospital stay ( 2.7 vs 3.8 days ) . Mean pelvic lymph node count was similar in the two groups ( 25 vs 31 ) . None of the robotic or laparoscopic procedures required conversion to laparotomy . The differences in major operative and postoperative complications between the two groups were not significant . All patients in both groups are alive and free of disease at the time of last follow up . Conclusion : Based on our experience , robotic radical hysterectomy appears to be equivalent to total laparoscopic radical hysterectomy with respect to operative time , blood loss , hospital stay , and oncological outcome . We feel the intuitive nature of the robotic approach , magnification , dexterity , and flexibility combined with significant reduction in surgeon 's fatigue offered by the robotic system will allow more surgeons to use a minimally invasive approach to radical hysterectomy INTRODUCTION Comparison of perioperative outcomes and recurrence in patients undergoing primary 
    Output:
    
Conclusion In our meta- analysis the rate of infectious complications associated with robotic-assisted hysterectomy was no different than that associated with conventional laparoscopic-assisted hysterectomy