***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 compare outcomes between robotic versus laparoscopic hysterectomy and lymphadenectomy in patients with endometrial cancer . METHODS A cohort study was performed by prospect ively identifying all patients with clinical stage I or occult stage II endometrial cancer who underwent robotic hysterectomy and lymphadenectomy from 2006 - 2008 and retrospectively comparing data using the same surgeons ' laparoscopic hysterectomy and lymphadenectomy cases from 1998 - 2005 , prior to our robotic experience . Patient demographics , operative times , complications , conversion rates , pathologic results , and length of stay were analyzed . RESULTS 181 patients ( 105 robotic and 76 laparoscopic ) met inclusion criteria . There was no significant difference between the two groups in  median age , uterine weight , bilateral pelvic or aortic lymph node counts , or complication rates in patients whose surgeries were completed minimally invasively . Despite a higher BMI ( 34 vs. 29 , P<0.001 ) , the estimated blood loss ( 100 vs. 250 mL , P<0.001 ) , transfusion rate ( 3 % vs. 18 % , RR 0.18 , 95%CI 0.05 - 0.64 , P=0.002 ) , laparotomy conversion rate ( 12 % vs. 26 % , RR 0.47 , 95%CI 0.25 - 0.89 , P=0.017 ) , and length of stay ( median : 1 vs. 2 nights , P<0.001 ) were lower in the robotic patients compared to the laparoscopic cohort . The odds ratio of conversion to laparotomy based on BMI for robotics compared to laparoscopy is 0.20 ( 95 % CI 0.08 - 0.56 , P=0.002 ) . The mean skin to skin time ( 242 vs. 287 min , P<0.001 ) and total room time ( 305 vs. 336 min , P<0.001 ) was shorter for the robotic cohort . CONCLUSION Robotic hysterectomy and lymphadenectomy for endometrial carcinoma can be accomplished in heavier patients and results in shorter operating times and hospital length of stay , a lower transfusion rate , and less frequent conversion to laparotomy when compared to laparoscopic hysterectomy and lymphadenectomy PURPOSE To demonstrate the feasibility of robot-assisted staging surgery using three arms in patients with endometrial cancer . METHODS One hundred nine patients with clinical stage I endometrial cancer who underwent staging surgery at Yonsei University Health System were enrolled from May 2006 to January 2009 . Patient demographics and operative outcomes were prospect ively collected . RESULTS Robotic surgery using three arms was performed in 28 patients , laparoscopy in 25 , and laparotomy in 56 . There were no differences among the three groups in terms of patient demographics . The number of harvested pelvic lymph nodes was lower in the laparoscopy group than in the laparotomy group ( 18.36 + /- 7.25 vs. 24.39 + /- 10.08 , respectively , P = 0.025 ) , but there was no difference between the robot and laparotomy groups . The number of resected para-aortic lymph nodes and operative time did not differ among the three groups . The average hospital stay was longer for the laparotomy group than the robot and laparoscopy groups ( 10.78 days vs. 7.92 days vs. 7.67 days , respectively , P < 0.001 ) . Operative complications and transfusions developed more frequently in the laparotomy group than in the robot and laparoscopy groups ( 25.0 % vs. 7.1 % vs. 8.0 % , respectively , P = 0.049 ; 42.9 % vs. 14.3 % vs. 16.0 % , respectively , P = 0.006 ) . CONCLUSION Robot-assisted surgery using three arms is a feasible method for surgical staging in patients with clinical stage I endometrial cancer OBJECTIVE : To evaluate the effect of introducing a robotic program on cost and patient outcome . METHODS : This was a prospect i ve evaluation of clinical outcome and cost after introducing a robotics program for the treatment of endometrial cancer and a retrospective comparison to the entire historical cohort . RESULTS : Consecutive patients with endometrial cancer who underwent robotic surgery ( n=143 ) were compared with all consecutive patients who underwent surgery ( n=160 ) before robotics .  The rate of minimally invasive surgery increased from 17 % performed by laparoscopy to 98 % performed by robotics in 2 years . The patient characteristics were comparable in both eras , except for a higher  body mass index  in the robotics era ( median 29.8 compared with 27.6 ; P<.005 ) . Patients undergoing robotics had longer operating times ( 233 compared with 206 minutes ) , but fewer adverse events ( 13 % compared with 42 % ; P<.001 ) , lower estimated median blood loss ( 50 compared with 200 mL ; P<.001 ) , and shorter median hospital stay ( 1 compared with 5 days ; P<.001 ) . The overall hospital costs were significantly lower for robotics compared with the historical group ( Can$7,644 compared with Can$10,368 [ Canadian dollars ] ; P<.001 ) even when acquisition and maintenance cost were included ( Can$8,370 compared with Can$10,368 ; P=.001 ) . Within 2 years after surgery , the short-term recurrence rate appeared lower in the robotics group compared with the historic cohort ( 11 recurrences compared with 19 recurrences ; P<.001 ) . CONCLUSION : Introduction of robotics for endometrial cancer surgery increased the proportion of patients benefitting from minimally invasive surgery , improved short-term outcomes , and result ed in lower hospital costs . LEVEL OF EVIDENCE : Purpose Laparoscopy ( LSC ) offers superior patient outcomes compared to laparotomy . Small retrospective/ prospect i ve series have suggested robotics offers further reduction in postoperative pain and pain medication use compared to st and ard LSC . Our objective was to compare postoperative pain in patients undergoing robotically assisted ( RBT ) versus st and ard LSC for newly diagnosed endometrial cancer . Methods All preoperative endometrial cancer cases scheduled for RBT and LSC from May 1 , 2007 to June 9 , 2010 were identified . For this analysis , we only included cases not requiring conversion to laparotomy . All patients were offered intravenous ( IV ) patient-controlled analgesia ( PCA ) postoperatively . Intraoperative equivalent fentanyl doses ( IEFDs ) and pain scores in the postanesthesia care unit ( PACU ) were assessed . Results IV PCA was used in 206 RBTs ( 86 % ) and 208 LSCs ( 88 % ) . Median IEFD was 425 μg for LSCs and 500 μg for RBTs ( P = 0.03 ) . Median pain scores on PACU arrival were similar in both groups . Median highest pain score was 5 for LSCs and 4 for RBTs ( P = 0.007 ) . Linear regression demonstrated that the IEFD was not correlated with the highest pain score ( R = 0.09 ; P = 0.07 ) . Fentanyl was used postoperatively in 196 of 206 RBTs ( 95 % ) and 187 of 208 LSCs ( 90 % ) . The total fentanyl doses were 242.5 ( range 0–2705 ) μg and 380 ( range 0–2625 ) μg , respectively ( P < 0.001 ) . The median hourly fentanyl doses were 16.7 ( range 0–122.5 ) μg and 23.5 ( range 0–132.4 ) μg , respectively ( P = 0.005 ) . Simultaneous multiple regression analysis further demonstrated RBT was independently associated with a lower total fentanyl dose compared to LSC ( P = 0.02 ) . Conclusions RBT is independently associated with significantly lower postoperative pain and pain medication requirements compared to LSC . The amount of intraoperative fentanyl analgesia does not appear to correlate with postoperative pain BACKGROUND Evaluation of the impact of a new robotic surgery programme on perioperative outcomes for endometrial cancer METHODS A prospect i ve data base of all patients undergoing staging for endometrial cancer during July 2007-July 2008 was collected and analysed . Demographic data and perioperative outcomes were compared between cases performed via laparotomy , laparoscopy and robotics . RESULTS Sixty-five patients underwent staging during the time of data collection ( LAP-26 , LSC-7 , ROB-32 ) . No difference in surgical volume in the year before vs. after robotics was identified . Median operative time for robotics and laparotomy was significantly less than for laparoscopy ( p = 0.023 ) . There was no significant difference in lymph node yields between the three groups ( p = 0.92 ) . Robotics was associated with significantly less blood loss ( p < 0.0001 ) . Complication rates were significantly lower in the robotic group compared to the laparotomy group ( p = 0.05 ) . Median hospital stay was 1 day for the minimally invasive groups . Total number of perioperative inpatient days decreased from 331 to 150 in one year . Practice management of endometrial cancer transitioned from a predominantly open approach ( 5.6 % LSC ) to robotics ( 11 % LSC , 49 % ROB ) within 12 months . CONCLUSIONS Robotic surgery dramatically altered our management of endometrial cancer and was associated with a significant improvement in several perioperative outcomes when compared to laparotomy and laparoscopy INTRODUCTION Comparison of perioperative outcomes and recurrence in patients undergoing primary surgical treatment for endometrial cancer by robotics , laparoscopy , vaginal/laparoscopy , or laparotomy approaches . METHODS Prospect i ve analysis of 67 patients undergoing robotic surgery for endometrial cancer between March 2004 and December 2007 . Comparison was made with similar patients operated between November 1999 and December 2006 by laparoscopy ( 37 cases ) , laparotomy ( 99 cases ) and vaginal/laparoscopy approach ( vaginal hysterectomy , bilateral adnexectomy/laparoscopic lymphadenectomy ) ( 47 cases ) and matched by age , body mass index ( BMI ) , histological type and International Federation of Gynecologists and Obstetricians ( FIGO ) staging . RESULTS Mean operating times for patients undergoing robotic , laparoscopy , vaginal/laparoscopy or laparotomy approach were 181.9 , 189.5 , 202.7 and 162.7 min , respectively ( p = 0.006 ) ; mean blood loss was 141.4 , 300.8 , 300.0 and 472.6 ml , respectively ( p < 0.001 ) ; mean number of nodes was 24.7 , 27.1 , 28.6 , and 30.9 , respectively ( p = 0.008 ) ; mean length of hospital stay was 1.9 , 3.4 , 3.5 and 5.6 days , respectively ( p < 0.001 ) . There were no significant differences in intra- or postoperative complications among the four groups . The conversion rate was 2.9 % for robotics and 10.8 % for the laparoscopy group ( 0.001 ) . There were no differences relative to recurrence rates among the four groups : 9 % , 14 % , 11 % and 15 % for robotics , laparoscopy , vaginal/laparoscopy , and laparotomy , respectively . CONCLUSION Robotics , laparoscopy and vaginal/laparoscopy techniques are preferable to laparotomy for suitable patients with endometrial cancer .  Robotics is preferable to laparoscopy due to a shorter hospital stay and lower conversion rate and preferable to vaginal/laparoscopy due to a reduced hospitalization BACKGROUND Previous studies comparing robotic-assisted laparoscopic surgery to traditional laparoscopic or open surgery in gynecologic oncology have been retrospective . To our knowledge , no prospect i ve r and omized trials have thus far been performed on endometrial cancer . OBJECTIVE We sought to prospect ively compare traditional and robotic-assisted laparoscopic surgery for endometrial cancer . STUDY DESIGN This was a r and omized controlled trial . From December 2010 through October 2013 , 101 endometrial cancer patients were r and omized to hysterectomy , bilateral salpingo-oophorectomy , and pelvic lymphadenectomy either by robotic-assisted laparoscopic surgery or by traditional laparoscopy .  The primary outcome measure was overall operation time . The secondary outcome measures included total time spent in the operating room , and surgical outcome ( number of lymph nodes harvested , complications , and recovery ) . The study was powered to show at least a 
    Output:
    
A robotic approach has favourable clinical outcomes but is more expensive