***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: 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 Computer-assisted telesurgical devices have recently been approved in the United States for general surgery . To determine the safety and efficacy of these procedures , we performed a prospect i ve trial of computer-enhanced “ robotic ” fundoplication compared to st and ard laparoscopic control procedures .  Consecutive patients undergoing surgical treatment for gastroesophageal reflux were included . The operating surgeon worked at a console using a three-dimensional image and manipulated h and controls .  Operative times , complications , and length of hospital stay were recorded . A st and ardized question naire was administered to evaluate symptoms . Twenty patients were entered into each group . There were no differences in age , preoperative weight , or sex . Operative times were significantly longer in the robot group ( 97 vs. 141 minutes ) . There were no complications and most patients went home the first postoperative day . At follow-up , symptoms were similar in both groups ; however , there was a significant difference in the number of patients taking antisecretory medication — none in the robotic group but six in the laparoscopic group reported regular use . Computer-assisted laparoscopic antireflux surgery is safe . However , operative times are longer , with little difference in outcomes . At the current level of technology and experience , robotic antireflux surgery appears to offer little advantage over st and ard laparoscopic approaches The background of this study is to compare prospect ively the oncological and functional results of  open radical prostatectomy ( OP ) and robotic prostatectomy ( RP )  from the experience of a single surgeon . Between June 2002 and June 2007 , 422 patients underwent radical prostatectomy ( OP 199 , RP 223 ) . We divided OP patients into 89 early cases ( OP-I ) and 110 late cases ( OP-II ) before and after introduction of a robotic system , and RP patients into 35 early cases ( RP-I ) and 188 late cases ( RP-II ) . Functional outcomes were measured by use of vali date d question naires completed by the patients . There were no significant differences in preoperative characteristics among the four groups , except that RP-I patients had lower biopsy Gleason scores . In the RP groups the mean estimated blood loss was lower and mean duration s of hospital stay and bladder catheterization were shorter compared to those of the OP groups . The frequency of intraoperative complications was significantly lower in the RP-II group . The positive surgical margin rates in the RP-II group were similar to or lower than those in the OP groups when stratified by pathologic stage T2 and T3 . From one month after surgery , RP-II patients had higher continence rates than OP-II patients . For patients ≥60 years old  , recovery of potency was better in the RP-II group . To conclude , RP by an experienced surgeon may have a similar or lower positive surgical margin rate than OP . Additionally , RP may lead to a shorter duration of bladder catheterization and hospital stay and better recovery of continence and potency than obtainable by OP Background — The incidence of silent cerebral lesions ( SCL ) after  atrial fibrillation ( AF ) ablation is highly variable , depending on the technology used . Recently , an increased risk for SCL has been described for a novel , nonirrigated ablation tool using multielectrode phased radiofrequency ( PVAC ) . The aim of this prospect i ve study was to evaluate the incidence and long-term follow-up of SCL in patients undergoing robotically assisted pulmonary vein isolation ( RA-PVI ) as compared with manual PVI .  Methods and Results — Circumferential PVI using irrigated radiofrequency current was performed on 70 patients ( 41 patients with paroxysmal AF , 59 % ) . Fifty patients underwent RA-PVI and 20 patients underwent a manual approach . Cerebral MRI was performed the day before and the day after the ablation procedure ; follow-up MRI was performed on 9 of 12 ( 75 % ) patients after a follow-up period of 21 months . SCLs were found in 12 of 70 ( 17 % ) patients in this study ; the incidence of SCLs was similar in patients undergoing RA-PVI as compared with manually ablated patients ( n=9 , 18 % versus n=3 , 15 % ; probability value=1.0 ) . In 1 patient undergoing manual PVI ( 1 % ) , an SCL with asymptomatic subarachnoid hemorrhage was detected ; the bleeding completely resolved within 1 month . Transient ischemic attack occurred in 1 ( 1 % ) patient 2 days after manual PVI . After a median follow-up period of 21 months , no residual SCLs were detected . Conclusions — The incidence of SCL using the robotic navigation system was 18 % in this study . Incidence and size of SCL appears to be similar after RA-PVI as compared with manual PVI . Repeat MRI showed no residual SCLs at long-term follow-up INTRODUCTION Lack of r and omized controlled trials ( RCTs ) that compare pure laparoscopic radical prostatectomy ( LRP ) with robot-assisted laparoscopic radical prostatectomy ( RALRP ) is an important gap of the literature related to the surgical treatment of the clinical ly localized prostate cancer ( PCa ) . AIM To provide the first prospect i ve r and omized comparison on the functional and oncological outcomes of LRP and RALRP for the treatment of the clinical ly localized PCa . METHODS Between 2007 and 2008 , 128 consecutive male patients were r and omized in two groups and treated by a single experienced surgeon with traditional LRP ( Group I-64 patients ) or RALRP ( Group II-64 patients ) in all cases with intent of bilateral intrafascial nerve sparing . MAIN OUTCOME MEASURES Primary end point was to compare the 12 months erectile function ( EF ) outcomes . Complication rates , continence outcomes , and oncological results were also compared . The sample size of our study was able , with an adequate power ( 1-beta > 0.90 ) , to recognize as significant large differences ( above 0.30 ) between incidence proportions of considered outcomes . RESULTS No statistically significant differences were observed for operating time , estimated blood loss , transfusion rate , complications , rates of positive surgical margins , rates of biochemical recurrence , continence , and time to continence . However , the 12-month evaluation of capability for intercourse ( with or without phosphodiesterase type 5 inhibitors ) showed a clear and significant advantage of RALRP ( 32 % vs. 77 % , P < 0.0001 ) . Time to capability for intercourse was significantly shorter for RALRP . Rates of return to baseline International Index of Erectile Function ( IIEF-6 ) EF domain score question naires ( questions 1 - 5 and 15 ) ( 25 % vs. 58 % ) and to IIEF-6 > 17 ( 38 % vs. 63 % ) were also significantly higher for RALRP ( P = 0.0002 and P = 0.008 , respectively ) . CONCLUSIONS Our study offers the first high-level evidence that RALRP provides significantly better EF recovery than LRP without hindering the oncologic radicality of the procedure . Larger RCTs are needed to confirm if a new gold-st and ard treatment in the field of RP has risen Background and aims Laparoscopic surgery has become the treatment of choice for cholecystectomy . Many studies showed that while this approach benefits the patient , the surgeon faces such distinct disadvantages as a poor ergonomic situation and limited degrees of freedom with limited motion as a consequence . Robots have the potential to overcome these problems . To evaluate the efficiency and feasibility of robotically assisted surgery ( RAC ) , we design ed a prospect i ve study to compare it with st and ard laparoscopic cholecystectomy ( SLC ) . Material s and methods Between 2001 and 2003 , 26 patients underwent SLC and 20 patients underwent RAC using the ZEUS system .  The feasibility , safety , and possible advantages were evaluated . To assess the efficacy , the total time in the operating room was divided into preoperative , operative , and postoperative time frames . Results For RAC in comparison with SLC , the preoperative phase including equipment setup was significantly longer . In the intraoperative phase , the cut-closure time and camera and trocar insertion times were significantly longer . It is interesting to note that the net dissection time for the cystic artery , duct , and the gall bladder was not different from SLC . Conclusions The study demonstrates the feasibility of robotically assisted cholecystectomy without system-specific morbidity . There is time loss in several phases of robotic surgery due to equipment setup and deinstallation and therefore , presents no benefit in using the robot in laparoscopic cholecystectomy PURPOSE Robotic assisted laparoscopic radical cystectomy for bladder cancer has been reported with potential for improvement in perioperative morbidity compared to the open approach . However , most studies are retrospective with significant selection bias . MATERIAL S AND METHODS A pilot prospect i ve r and omized trial evaluating perioperative outcomes and oncologic efficacy of open vs robotic assisted laparoscopic radical cystectomy for consecutive patients was performed from July 2009 to June 2011 . RESULTS To date 47 patients have been r and omized with data available on 40 patients for analysis . Each group was similar with regard to age , gender , race , body mass index and comorbidities , as well as previous surgeries , operative time , postoperative complications and final pathological stage . We observed no significant differences between oncologic outcomes of positive margins ( 5 % each , p = 0.50 ) or number of lymph nodes removed for open radical cystectomy ( 23 , IQR 15 - 28 ) vs robotic assisted laparoscopic radical cystectomy ( 11 , IQR 8.75 - 21.5 ) groups ( p = 0.135 ) . The robotic assisted laparoscopic radical cystectomy group ( 400 ml , IQR 300 - 762.5 ) was noted to have decreased estimated blood loss compared to the open radical cystectomy group ( 800 ml , IQR 400 - 1,100 ) and trended toward a decreased rate of excessive length of stay ( greater than 5 days ) ( 65 % vs 90 % , p = 0.11 ) compared to the open radical cystectomy group . The robotic group also trended toward fewer transfusions ( 40 % vs 50 % , p = 0.26 ) . CONCLUSIONS Our study vali date s the concept of r and omizing patients with bladder cancer undergoing radical cystectomy to an open or robotic approach . Our results suggest no significant differences in surrogates of oncologic efficacy . Robotic assisted laparoscopic radical cystectomy demonstrates potential benefits of decreased estimated blood loss and decreased hospital stay compared to open radical cystectomy . Our results need to be vali date d in a larger multicenter prospect i ve r and omized clinical trial Current options for minimally invasive surgical treatment of single-vessel coronary artery disease include beating heart procedures without cardiopulmonary bypass ( CPB ) via mini-thoracotomy ( MIDCAB ) and totally endoscopic robot-assisted techniques ( TECAB ) with CPB . Both procedures are associated with potential myocardial stress before revascularization , such as single-lung ventilation ( SLV ) , temporary coronary artery occlusion , cardiac luxation , intrathoracic carbon dioxide insufflation , and extended CPB and operating time . In this echocardiographic study we sought to evaluate the extent of intraoperative segmental wall motion abnormalities ( SWMA ) during MIDCAB and TECAB surgery and to identify factors affecting SWMA .  Forty-six patients with single-vessel coronary artery disease were studied . Sixteen patients were operated using the MIDCAB technique and 30 patients with TECAB .  In both groups sequential trans 
    Output:
    
The benefits of robotic surgery lacked robustness on RCT -sensitivity analyses .
Conclusions Our results showed that robotic surgery contributed positively to some perioperative outcomes but longer operative times remained a shortcoming .