***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 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 To compare health‐related quality ‐of‐life ( HRQoL ) outcomes for robot‐assisted laparoscopic radical cystectomy ( RARC ) with those of traditional open radical cystectomy ( ORC ) in a prospect i ve r and omised fashion Non-r and omised studies of the effects of interventions are critical to many areas of healthcare evaluation , but their results may be biased . It is therefore important to underst and and appraise their strengths and weaknesses . We developed ROBINS-I ( “ Risk Of Bias In Non-r and omised Studies - of Interventions ” ) , a new tool for evaluating risk of bias in estimates of the comparative effectiveness ( harm or benefit ) of interventions from studies that did not use r and omisation  to allocate units ( individuals or clusters of individuals ) to comparison groups . The tool will be particularly useful to those undertaking systematic review s that include non-r and omised studies BACKGROUND More than a decade since its inception , the benefits and cost efficiency of robot-assisted radical prostatectomy ( RARP ) continue to elicit controversy . OBJECTIVE To compare outcomes and costs between RARP and open RP ( ORP ) . DESIGN , SETTING , AND PARTICIPANTS A cohort study of 629 593 men who underwent RP for localized prostate cancer at 449 hospitals in the USA from 2003 to 2013 , using the Premier Hospital Data base . INTERVENTION RARP was ascertained through a review of the hospital charge description master for robotic supplies . OUTCOME MEASURES AND STATISTICAL ANALYSIS Outcomes were 90-d postoperative complications ( Clavien ) , blood product transfusions , operating room time ( ORT ) , length of stay ( LOS ) , and direct hospital costs . Propensity-weighted regression analyses accounting for clustering by hospitals and survey weighting ensured nationally representative estimates . RESULTS AND LIMITATIONS RARP utilization rapidly increased from 1.8 % in 2003 to 85 % in 2013 ( p<0.001 ) . RARP patients ( n=311 135 ) were less likely to experience any complications ( odds ratio [ OR ] 0.68 , p<0.001 ) or prolonged LOS ( OR 0.28 , p<0.001 ) , or to receive blood products ( OR 0.33 , p=0.002 ) compared to ORP patients ( n=318 458 ) . The adjusted mean ORT was 131min longer for RARP ( p=0.002 ) . The 90-d direct hospital costs were higher for RARP ( + $ 4528 , p<0.001 ) , primarily attributed to operating room and supplies costs . Costs were no longer signficantly different between ORP and RARP among the highest-volume surgeons ( ≥104 cases/yr ; + $ 1990 , p=0.40 ) and highest-volume hospitals ( ≥318 cases/yr ; + $ 1225 , p=0.39 ) . Limitations include the lack of oncologic characteristics and the retrospective nature of the study . CONCLUSIONS Our contemporary analysis reveals that RARP confers a perioperative morbidity advantage at higher cost . In the absence of large r and omized trials because of the widespread adoption of RARP , this retrospective study represents the best available evidence for the morbidity and cost profile of RARP versus ORP . PATIENT SUMMARY In this large study of men with prostate cancer who underwent either open or robotic radical prostatectomy  , we found that robotic surgery has a better morbidity profile but costs more AIM In this study , we compared perioperative and oncologic outcomes of patients treated with either open or robot-assisted radical cystectomy and intracorporeal neobladder at a tertiary care center . METHODS The institutional prospect i ve bladder cancer data base was queried for " cystectomy with curative intent " and " neobladder " . All patients underwent robot-assisted radical cystectomy and intracorporeal neobladder or open radical cystectomy and orthotopic neobladder for high- grade non-muscle invasive bladder cancer or muscle invasive bladder cancer with a follow-up length ≥2 years were included . A 1:1 propensity score matching analysis was used . Kaplan-Meier method was performed to compare oncologic outcomes of selected cohorts . Survival rates were computed at 1,2,3 and 4 years after surgery and the log rank test was applied to assess statistical significance between the matched groups . RESULTS Overall , 363 patients ( 299 open and 64 robotic ) were included .  Open radical cystectomy patients were more frequently male ( p = 0.08 ) , with higher pT stages ( p = 0.003 ) , lower incidence of urothelial histologies ( p = 0.05 ) and lesser adoption of neoadjuvant chemotherapy ( < 0.001 ) . After applying the propensity score matching , 64 robot 
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Additionally , there were no differences in postoperative quality of life score assessment at 3 and 6 months between robot-assisted radical cystectomy and open radical cystectomy .
Robot-assisted radical cystectomy is associated with less blood loss and lower transfusion rates .
There is no difference in complications , length of stay , mortality , and quality of life between robot-assisted radical cystectomy and open radical cystectomy .