***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: 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 Abstract Background Single-incision laparoscopic cholecystectomy evolved from the traditional multiport laparoscopic technique . Prior trials have demonstrated improved cosmesis with the single-incision technique . Robotic single-site surgery minimizes the technical difficulties associated with laparoscopic single-incision approach . This is the first prospect i ve , r and omized , controlled study comparing robotic single-site cholecystectomy ( RSSC ) and multiport laparoscopic cholecystectomy ( MPLC ) in terms of cosmesis and patient satisfaction . Methods Patients with symptomatic benign gallbladder disease were r and omized to RSSC or MPLC . Data included perioperative variables such as operative time , conversion and complications and cosmesis satisfaction , body image perception , quality of life using vali date d question naires , at postoperative visits of 2 , 6 weeks and 3 months . Results One hundred thirty-six patients were r and omized to RSSC ( N = 83 ) and MPLC ( N = 53 ) at 8 institutions . Both cohorts were dominated by higher enrollment of females ( RSSC = 78 % , MPLC = 92 % ) . The RSSC and MPLC cohorts were otherwise statistically matched . Operative time was longer for RSSC ( 61 min vs. 44 min , P < 0.0001 ) . There were no differences in complication rates .  RSSC demonstrated a significant superiority in cosmesis satisfaction and body image perception ( P value < 0.05 at every follow-up ) . There was no statistically significant difference in patient-reported quality of life . Multivariate analysis of female patients demonstrated significantly higher preference for RSSC over MPLC in cosmesis satisfaction and body image perception with no difference seen in overall quality of life . Conclusions Results from this trial show that RSSC is associated with improved cosmesis satisfaction and body image perception without a difference in observed complication rate . The uncompromised safety and the improved cosmesis satisfaction and body image perception provided by  RSSC for female patients support consideration of the robotic single-site approach . Clinical Trials.gov identifier NCT01932216 Open radical prostatectomy ( ORP ) is the reference st and ard for the surgical management of localized prostate cancer . With wider availability of minimally invasive radical prostatectomy techniques , there is a debate regarding the st and ard treatment of the management of localized prostate cancer . Therefore , we review ed the current status of laparoscopic radical prostatectomy ( LRP ) and robotic-assisted laparoscopic radical prostatectomy ( RALRP ) as compared with ORP . Because no prospect i ve , r and omized trials comparing the different techniques have been performed , outcomes must be assessed from published series by centers that focus on ORP , LRP , and RALRP . Aside from reducing the amount of blood loss , current data suggest that the most significant outcomes ( cure , continence , and potency ) are no better with LRP or RALRP than with conventional ORP . Therefore , in experienced h and s , ORP remains the gold st and ard procedure . However , there is a trend toward consistently better outcomes following RALRP in comparison with LRP . In the end , individual patient outcomes can be maximized by choosing the best modality based on the patient 's comorbid medical conditions , cancer characteristics , and surgeon experience . Future studies are needed to further investigate long-term cancer control as well as functional outcomes for RALRP series Background : Traditional laparoscopic anterior rectal resection ( TLAR ) has recently been used for rectal cancer , offering good functional results compared with open anterior resection and result ing in a better postoperative early outcome . However , laparoscopic rectal resection can be technically dem and ing , especially when a total mesorectal excision is required . The aim of this study was to verify whether robot-assisted anterior rectal resection ( RLAR ) could overcome limitations of the laparoscopic approach . Methods : Sixty-six patients with rectal cancer were enrolled in the study . Twenty-nine patients underwent RLAR and 37 TLAR .  Groups were matched for age , BMI , sex ratio , ASA status , and TNM stage , and were followed up for a mean time of 12 months . Results : Robot-assisted laparoscopic rectal resection results in shorter operative time when a total mesorectal excision is performed ( 165.9±10 vs 210±37 minutes ; P<0.05 ) . The conversion rate is significantly lower for RLAR ( P<0.05 ) . Postoperative morbidity was comparable between groups . Overall survival and disease-free survival were comparable between groups , even though a trend towards better disease-free survival in the RLAR group was observed . Conclusion : RLAR is a safe and feasible procedure that facilitates laparoscopic total mesorectal excision . R and omized clinical trials and longer follow-ups are needed to evaluate a possible influence of RLAR on patient survival OBJECTIVE : To compare conventional laparoscopic and robotic-assisted laparoscopic sacrocolpopexy for vaginal apex prolapse . METHODS : This single-center , blinded r and omized trial included participants with stage 2–4 posthysterectomy vaginal prolapse . Participants were r and omized to laparoscopic or robotic sacrocolpopexy .  The primary outcome was total operative time from incision to closure . Secondary outcomes were postoperative pain , functional activity , bowel and bladder symptoms , quality of life , anatomic vaginal support , and cost from a health care system perspective . RESULTS : A total of 78 patients enrolled and were r and omized ( laparoscopic n=38 ; robotic n=40 ) .  Total operative time was significantly longer in the robotic group compared with the laparoscopic group ( + 67-minute difference ; 95 % confidence interval [ CI ] 43–89 ; P<.001 ) . Anesthesia time , total time in the operating room , total sacrocolpopexy time , and total suturing time were all significantly longer in the robotic group . Participants in the robotic group also had significantly higher pain at rest and with activity during weeks 3 through 5 after surgery and required longer use of nonsteroidal anti-inflammatory drugs ( median , 20 compared with 11 days , P<.005 ) . The robotic group incurred greater cost than the laparoscopic group ( mean difference + $ 1,936 ; 95 % CI $ 417–$3,454 ; P=.008 ) . Both groups demonstrated significant improvement in vaginal support and functional outcomes 1 year after surgery with no differences between groups . CONCLUSION : Robotic-assisted sacrocolpopexy results in longer operating time and increased pain and cost compared with the conventional laparoscopic approach . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00551993 . LEVEL OF EVIDENCE : OBJECTIVE The purpose of this study was to compare operative time and intra- and postoperative complications between  total laparoscopic hysterectomy and robotic-assisted total laparoscopic hysterectomy .  STUDY DESIGN This study was a blinded , prospect i ve r and omized controlled trial conducted at 2 institutions . Subjects consisted of women who planned laparoscopic hysterectomy for benign indications . Preoperative r and omization to total laparoscopic hysterectomy or robotic-assisted total laparoscopic hysterectomy was stratified by surgeon and uterine size ( > or ≤12 weeks ) . Vali date d question naires , activity assessment scales , and visual analogue scales were administered at baseline and during follow-up evaluation . RESULTS Sixty-two women gave consent and were enrolled and r and omly assigned ; 53 women underwent surgery ( laparoscopic , 27 women ; robot-assisted , 26 women ) . There were no demographic differences between groups . Compared with laparoscopic hysterectomy , total case time ( skin incision to skin closure ) was significantly longer in the robot-assisted group ( mean difference , + 77 minutes ; 95 % confidence interval , 33 - 121 ; P < .001 ] as was total operating room time ( entry into operating room to exit ; mean difference , + 72 minutes ; 95 % confidence interval , 14 - 130 ; P = .016 ) . Mean docking time was 6 ± 4 minutes . There were no significant differences between groups in estimated blood loss , pre- and postoperative hematocrit change , and length of stay . There were very few complications , with no difference in individual complication types or total complications between groups . Postoperative pain and return to daily activities were no different between groups . CONCLUSION Although laparoscopic and robotic-assisted hysterectomies are safe approaches to hysterectomy , robotic-assisted hysterectomy requires a significantly longer operative time Background A new technical tool was developed and introduced into the therapeutic field of videoscopic surgery — robotic telemanipulation surgery . The aim of this study is to investigate in a prospect i ve r and omized trial the feasibility of the Nissen procedure using the da Vinci and to evaluate the benefits and the costs of this new technique compared with the conventional laparoscopic approach . Material s and methods Twenty patients with gastro-esophageal reflux disease ( GERD ) were r and omized into laparoscopic Nissen versus robot-assisted Nissen fundoplication . All the patients signed an informed consent document . The time data of the procedure , the efficacy of the instruments , the intra-operative incidents , postoperative morbidity , and cost minimization are presented . Results Nine patients were assigned to the robot , and 11 to the  laparoscopic procedure . Both groups were similar in age , male/female ratio , and body mass index . The robot procedure time was significantly longer . The hospital stay and the alimentation day were similar . The number of postoperative complaints was similar after the 1st , 6th , and 12th postoperative months . However , on the 3rd postoperative month , the number of complaints was significantly higher in the robot group . The robot procedure was more expensive with regard to the instrumentation and reusable material , the nursing costs , the investment costs , and the maintenance costs . Conclusions No clear advantage of using robotics in the Nissen procedure was observed . The procedure seems to be feasible and safe . The technique is limited because of unadapted instruments . The disadvantages are the high costs and prolonged operative time Background Robotic technology represents the latest development in minimally-invasive surgery . Nevertheless , robotic-assisted surgery seems to have specific disadvantages such as an increase in costs and prolongation of operative time . A general clinical implementation of the technique would only be justified if a relevant improvement in outcome could be demonstrated . This is also true for laparoscopic fundoplication . The present study was design ed to compare robotic-assisted ( RALF ) and conventional laparoscopic fundoplication ( CLF ) with the focus on operative time , costs und perioperative outcome . Methods Forty patients with gastro-esophageal reflux disease were r and omized to either RALF by use of the daVinci ® Surgical System or CLF . Nissen fundoplication was the st and ard anti-reflux procedure . Peri-operative data such as length of operative procedure , intra- and postoperative complications , length of hospital stay , overall costs and symptomatic short-term outcome were 
    Output:
    
FINDINGS CLS shows significant advantages in total operative time , net operative time , total complication rate , and operative cost ( p < 0.05 in all cases ) , whereas the estimated blood loss was less in RLS ( p < 0.05 ) .
Despite higher operative cost , RLS does not result in statistically better treatment outcomes , with the exception of lower estimated blood loss .
Operative time and total complication rate are significantly more favorable with CLS