***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: 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 Introduction : Open radical cystectomy ( ORC ) has been the st and ard treatment for muscle-invasive bladder cancer , but this is associated with significant morbidity and mortality . Robot-assisted radical cystectomy ( RARC ) has been proposed as minimally invasive alternative with improved morbidity and acceptable oncological outcomes , but a large series featuring RARC and their comparison with ORC is still lacking in India despite more than a decade of its inception . We have conducted this study with an objective to see the feasibility of RARC in the Indian context and compare it with contemporary st and ard . Methods : This is a prospect i ve cohort study conducted at two tertiary cancer institutes . We have evaluated the patients pertaining to operative and early post-operative factors from January 2014 to December 2015 . Necessary statistical tests applied to see comparability of the arms and their outcomes . Results : A total of 170 patients underwent surgery for carcinoma bladder ( 45 ORC while 125 RARC ) .  Intraoperative blood loss ( RARC and ORC : 228 and 529 ml ) and average transfusion rate were lower with RARC . A trend towards benefit was noted in favour of robotic arm in terms of mean complication rate  ( RARC and ORC : 54 and 39 % ) . Conclusions : The present study has shown comparable surgical and early post-operative outcomes with clear advantage of robotic approach in terms of intraoperative blood transfusion and lymph node yield . Although the study was non-r and omised in nature , it should provide substantial evidence on safety and feasibility of RARC in the Indian context and a reference point of evidence to look ahead OBJECTIVES Over the past decade , robot-assisted radical cystectomy ( RARC ) has gained traction as an alternative to the conventional open approach open radical cystectomy ( ORC ) . However , the benefits of RARC over ORC remain unclear . Our objective was to conduct a comparative effectiveness analysis between RARC and ORC using data from the National Cancer Data Base . MATERIAL S AND METHODS Within the National Cancer Data Base , we identified patients with localized muscle-invasive bladder cancer who underwent RC between 2010 and 2013 . Patients were stratified according to surgical approach : ORC vs. RARC . Intraoperative endpoints included : the presence of positive surgical margins , the performance of a pelvic lymph node dissection , and number of lymph nodes ( LN ) removed . Postoperative endpoints included : length of stay ( LOS ) , 30- and 90-day postoperative mortality ( POM ) rates , 30-day readmission rate , and overall survival ( OS ) . To minimize selection bias , observed differences in baseline characteristics between RARC vs. ORC patients were controlled for using weighted propensity scores . Binary endpoints and OS were assessed using propensity score-adjusted logistic and Cox regression analyses , respectively . POM was assessed using propensity score weighted Kaplan-Meier survival estimates at 30 and 90 days after RC . RESULTS Of 9,561 patients who underwent RC , 2,048 ( 21.4 % ) and 7,513 ( 78.6 % ) underwent RARC and ORC , respectively . The use of RARC increased over time , from 16.7 % in 2010 to 25.3 % in 2013 . With regard to intraoperative outcomes , RARC was associated with equivalent rates of positive surgical margins ( 9.3 % vs. 10.7 % , odds ratio [ OR ] = 0.86 , 95 % CI : 0.72 - 1.03 ; P = 0.10 ) , higher rates of pelvic lymph node dissection ( 96.4 % vs. 92.0 % , OR = 2.30 , 95 % CI : 1.67 - 3.16 ; P<0.001 ) , higher median LN count ( 17 vs. 12 , P<0.001 ) , higher rates of LN count above the median ( 56.8 % vs. 40.4 % , OR = 1.94 , 95 % CI : 1.55 - 2.42 , P<0.001 ) . With regard to postoperative outcomes , receipt of RARC was associated with a shorter median LOS ( 7 vs. 8 , P<0.001 ) , and lower rates of pLOS ( 45.0 % vs. 54.8 % , OR = 0.68 , 95 % CI : 0.58 - 0.79 ; P<0.001 ) . The 30- and 90-day POM rates were 2.8 % , 6.7 % for ORC , and 1.4 % , 4.8 % for RARC , respectively ( hazard ratio [ HR ] = 0.48 , 95 % CI : 0.29 - 0.80 , P = 0.005 and HR = 0.71 , 95 % CI : 0.54 - 0.93 ; P = 0.014 ) . Finally , with a mean follow-up of 26.9 months , on IPTW-adjusted Cox regression analysis , RARC vs. ORC was associated with a benefit in OS ( HR = 0.79 , 95 % CI : 0.71 - 0.88 ; P<0.001 ) . CONCLUSIONS Our large contemporary study found an increased adoption of RARC between 2010 and 2013 , with more than 1 out of 4 patients undergoing  RARC by the end of the study period . We found that RARC was associated with higher LN counts , shorter LOS , and lower POM . Our results allude to potential benefits of RARC while we wait for more definitive answers from r and omized trials Introduction : Open radical cystectomy ( RC ) is associated with significant morbidity and the role of minimally invasive surgery ( MIS ) in reducing morbidity of RC is controversial A direct comparison of various surgical modalities on perioperative outcomes is lacking in the Indian literature . We evaluated outcomes of minimally invasive ( robotic and laparoscopic ) versus open RC with pelvic lymph node dissection ( PLND ) performed at our institute from 2014 to 2016 . Methods : Eighty-three patients of RC with PLND were prospect ively analyzed from December 2014 to February 2016 . All patients of muscle invasive urothelial cancer of the bladder undergoing RC ( open or MIS ) were included in the study . Based on patients preference they were assigned to one of the three groups ( Open RC , robot-assisted RC , or laparoscopic RC ) . Their demographic profile , preoperative disease stage , operative data like operative time , blood loss , intraoperative complications , histopathological data like pathological stage , lymph-node yield etc . , postoperative complications if any and total duration of stay were recorded . These data of laparoscopic , open , and robotic cystectomies were compared in terms of various demographic , histopathologic parameters and perioperative outcomes . Results : Twenty-nine patients ( 34.93 % ) underwent minimally invasive RC with PLND ( 5 laparoscopic and 24 robotic ) . The median age of patients was 58 years .  Mean number of lymph nodes removed was 22.5 ± 14.6 . The total number of lymph nodes removed in laparoscopic surgery was 104 with a yield of 20.6 per patient , in robotic surgery were 627 with a yield of 26.1 per patient , and in open surgery were 1119 with a yield of 20.7 per patient ( P = 0.004 ) . Clavien-Dindo Grade 2 and 3 complications were seen in 37.5 % of robotic , 60 % of laparoscopic , and 55.54 % of open RC . Average blood loss and operative time in laparoscopic , robotic , and open RC were 511.53 ± 311.02 ml , 552.08 ± 267.63 ml , and 512.05 ± 213.9 ml and 8.23 ± 1.36 h ( hrs ) , 7.53 ± 1.92 h , and 5.85 ± 1.76 h , respectively ( P = 0.68 and < 0.001 , respectively ) . Conclusions : MIS is associated with significantly longer operative time than open RC . Robotic RC has significantly higher lymph node yield than open or laparoscopic RC . Minimally invasive RC is equivalent to open surgery in terms of perioperative morbidity , mortality , and blood loss OBJECTIVE To evaluate our initial robotic-assisted radical cystectomy ( RARC ) experience compared with a robust open radical cystectomy ( ORC ) series performed at a single institution using a matched-pair analysis . Although early results suggest that RARC is safe , with favorable perioperative and early oncologic outcomes , limited data exist comparing ORC and RARC . METHODS  RARC and ORC patients were identified through a prospect ively maintained institutional review board-approved bladder cancer data base . RARC and ORC cases performed from September 2007 to November 2010 were matched 1:2 by age , sex , urinary diversion , and clinical stage . The perioperative , complication , and pathologic outcomes were compared . RESULTS A total of 50 RARC and 100 ORC cases were review ed , with a median follow-up of 8 and 13.5 months , respectively . No differences in the demographic parameters were present between the 2 groups . RARC was associated with a significantly decreased median estimated blood loss ( 350 vs 475 mL ) and 30-day transfusion rate ( 2 % vs 24 % ) but with longer operative times ( 454.9 vs 349.1 minutes ) . No difference was found in the rate of 30-day minor or major Clavien complications , length of stay , or 30-day readmissions between groups . The 90-day mortality rate was 3 % versus 0 % for ORC and RARC , respectively . No difference in the final pathologic findings , number of lymph nodes removed , or margin status was identified . CONCLUSION Early experience with RARC compared with a robust ORC experience demonstrated similar perioperative and pathologic outcomes . Continued experience with RARC has the potential to bring improved perioperative results Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more PURPOSE We present the characteristics and outcomes of a large , contemporary , consecutive series of patients treated with radical cystectomy and pelvic lymphadenectomy for transitional cell carcinoma of the bladder . MATERIAL S AND METHODS We developed a multi-institutional data base and collected retrospective and prospect i ve data on 888 consecutive patients with bladder transitional cell carcinoma who were treated with radical cystectomy and pelvic lymphadenectomy at 3 academic centers in the United States between 1984 and 2003 . RESULTS Of the 
    Output:
    
Conclusions Based on the current evidence , there is no difference in the rate of PSMs , lymph node yield , recurrence rate and location as well as short-term survival outcomes between RARC and ORC in RCTs .