***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: Background A variety of minimally invasive parathyroidectomy ( MIP ) techniques have been currently introduced to surgical management of primary hyperparathyroidism ( pHPT ) caused by a solitary parathyroid adenoma . This study aim ed at comparing the video-assisted MIP ( MIVAP ) and open MIP ( OMIP ) in a prospect i ve , r and omized , blinded trial . Material s and Methods Among 84 consecutive pHPT patients referred for surgery , 60 individuals with concordant localization of parathyroid adenoma on ultrasound and subtraction Tc99m-MIBI scintigraphy were found eligible for MIP  under general anesthesia and were r and omized to two groups ( n = 30 each ) : MIVAP and OMIP . An intraoperative intact parathyroid hormone ( iPTH ) assay was routinely used in both groups to determine the cure . Primary end-points were the success rate in achieving the cure from hyperparathyroid state and hypocalcemia rate . Secondary end-points were operating time , scar length , pain intensity assessed by the visual-analogue scale , analgesia request rate , analgesic consumption , quality of life within 7 postoperative days ( SF-36 ) , cosmetic satisfaction , duration of postoperative hospitalization , and cost-effectiveness analysis . Results All patients were cured . In 2 patients , an intraoperative iPTH assay revealed a need for further exploration : in one MIVAP patient , subtotal parathyroidectomy for parathyroid hyperplasia was performed with the video-assisted approach , and in an OMIP patient , the approach was converted to unilateral neck exploration with the final diagnosis of double adenoma . MIVAP versus OMIP patients were characterized by similar operative time ( 44.2 ± 18.9 vs. 49.7 ± 15.9 minutes ; P = 0.22 ) , transient hypocalcemia rate ( 3 vs. 3 individuals ; P = 1.0 ) , lower pain intensity at 4 , 8 , 12 , and 24 hours after surgery ( 24.9 ± 6.1 vs. 32.2 ± 4.6 ; 26.4 ± 4.5 vs. 32.0 ± 4.0 ; 19.6 ± 4.9 vs. 25.4 ± 3.8 ; 15.5 ± 5.5 vs. 20.4 ± 4.7 points , respectively ; P < 0.001 ) , lower analgesia request rate ( 63.3 % vs. 90 % ; P = 0.01 ) , lower analgesic consumption ( 51.6 ± 46.4 mg vs. 121.6 ± 50.3 mg of ketoprofen ; P < 0.001 ) , better physical functioning aspect and bodily pain aspect of the quality of life on early recovery ( 88.4 ± 6.9 vs. 84.6 ± 4.7 and 90.3 ± 4.7 vs. 87.5 ± 5.8 ; P = 0.02 and P = 0.003 , respectively ) , shorter scar length ( 17.2 ± 2.2 mm vs. 30.8 ± 4.0 mm ; P < 0.001 ) , and higher cosmetic satisfaction rate at 1 month after surgery ( 85.4 ± 12.4 % vs. 77.4 ± 9.7 % ; P = 0.006 ) . Cosmetic satisfaction was increasing with time , and there were no significant differences at 6 months postoperatively . MIVAP was more expensive ( US$ 1,150 ± 63.4 vs. 1,015 ± 61.8 ; P < 0.001 ) while the mean hospital stay was similar ( 28 ± 10.1 vs. 31.1 ± 9.7 hours ; P = 0.22 ) . Differences in serum calcium values and iPTH during 6 months of follow-up were nonsignificant . Transient laryngeal nerve palsy appeared in one OMIP patient ( P = 0.31 ) . There was no other morbidity or mortality . Conclusions Both MIVAP and OMIP offer a valuable approach for solitary parathyroid adenoma with a similar excellent success rate and a minimal morbidity rate . Routine use of the intraoperative iPTH assay is essential in both approaches to avoid surgical failures of overlooked multigl and ular disease . The advantages of MIVAP include easier recognition of recurrent laryngeal nerve ( RLN ) , lower pain intensity within 24 hours following surgery , lower analgesia request rate , lower analgesic consumption , shorter scar length , better physical functioning and bodily pain aspects of the quality of life on early recovery , and higher early cosmetic satisfaction rate . However , these advantages are achieved at higher costs because of endoscopic tool involvement BACKGROUND AND PURPOSE Robotic surgery allows three-dimensional ( 3D ) viewing of tissues . We compared two-dimensional ( 2D ) and 3D suturing drills using the daVinci surgical system to determine if the latter is advantageous . MATERIAL S AND METHODS Twenty-eight anastomotic drills were completed by seven surgeons using the daVinci robot . Three surgeons had considerable ( > 6 months ) robotic experience , and four had none .  Drills were performed r and omly in both dimensional modes in a blinded fashion . Drill 1 was an interrupted four stitch and drill 2 a running closure . All tasks were kept uniform . We recorded time to completion , difficulty , and accuracy . The drills were evaluated by two independent review ers for accuracy and major errors ( i.e. , broken suture , torn graft ) . RESULTS The average operative time per drill in two dimensions was 13.1 minutes ( range 6.9 - 21.9 minutes ) and in three dimensions was 8.5 minutes ( range 4.7 - 12.8 minutes ) ( P<0.001 ) . Drill 1 was 6.1 minutes faster in three dimensions ( mean 9.2 minutes ; P<0.01 ) , and drill 2 was 2.9 minutes faster ( mean 7.8 minutes ; P=0.03 ) . Both advanced and novice groups were faster in 3D ( P<0.01 ) . There were two major errors in the 3D performances and 5 in the 2D exercises ( P<0.05 ) . The participants correctly identified the dimensional mode 92.9 % of the time ( P<0.01 ) . CONCLUSION The anastomosis was completed 65 % faster using 3D with equal , if not greater , accuracy . Drill 1 was improved to a greater degree than drill 2 , suggesting most benefit of 3D views during knot tying . Use of three dimensions outperformed two dimensions in both groups . Surgeons can immediately benefit from 3D viewing during robotic surgery 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 Robotic laparoscopic surgery is postulated to result in better surgical results by allowing improved instrument manipulation and three-dimensional vision . The authors ’ experience performing robot-assisted laparoscopic colorectal surgery is reported . METHOD : St and ard laparoscopic procedures with robot-assisted laparoscopic colon mobilization and vascular ligation were performed . Data relating to the operative procedure , hospital stay , and direct costs were collected . Results were compared with age , gender , and procedure case-matched controls taken from a prospect i ve laparoscopic colorectal surgery data base . RESULTS : Six robot-assisted laparoscopic surgeries ( 2 right hemicolectomies , 3 sigmoid colectomies , and 1 Wells rectopexy ) were performed between December 2001 and June 2002 . There was no associated morbidity . Operative time was increased from a median time of 108 minutes for st and ard laparoscopic colorectal surgery to 165 minutes for robot-assisted laparoscopic surgeries ( P = 0.0313 ; Wilcoxon matched-pairs signed-rank test for non-parametric data ) . This was primarily a result of the time required for robot set-up . Blood loss , length of stay , and hospital cost were not significantly different between groups . Additional direct equipment costs for RAC cases included robotic laparoscopic instruments and sterile drapes ( approximately US $ 350 per case ) , without including acquisition and maintenance costs for the robot . CONCLUSION : Robot-assisted laparoscopic colectomy is a feasible and safe procedure . Although three-dimensional vision and dexterity are facilitated , operative time is increased and the overall additional expense of robotics is of concern . Robot-assisted laparoscopic colectomy requires further evaluation to establish clinical and financial benefits before introduction to routine practice . Such techniques may , in the future , facilitate complex laparoscopic techniques Background This study aim ed to investigate the effect of a virtual reality simulator on the learning of basic robotic suturing skills . Methods Two r and omized groups of students underwent a controlled training program . Both groups completed an identical test before and after training . The increase in the number of stitches placed during the pretest and posttest was used as an objective measure of the training effect . To evaluate the subjective feeling of underst and ing and mastering , the students indicated this on a visual analog scale . Results Both groups showed a significant increase in the number of stitches placed during the posttest , and an increase in subjective feeling of underst and ing and mastering . The increase did not differ between the groups , indicating that the virtual reality simulator equaled the mechanical trainer in training of robotic suturing technique . Conclusions Training in basic robot-assisted suturing skills using a virtual reality simulator without additional training equaled training using a mechanical simulator Objective : This study aim ed to compare the outcomes of laparoscopic resection ( LR ) with open resection ( OR ) for right-sided colon cancer . Methods : During the study period from June 2000 to December 2004 , 182 patients ( 84 men ) underwent elective resection for cancer of the right colon . Laparoscopic resection was performed in 77 patients , while 105 patients had open operations . Patients who underwent operations on an emergency basis were excluded . Data on the patients ' demographics , operative details , and postoperative complications were collected prospect ively . The outcomes of patients with laparoscopic resection  were compared with those of patients with  open surgery . Results : There was no difference in the age , sex , presence of premorbid medical conditions , and blood loss between the 2 groups . The mean operative time for open resection was 115.4 minutes and that for laparoscopic resection was 165.1 minutes ( P<0.001 ) . Among the 77 patients who underwent laparoscopic resection , 7 ( 9 % ) required conversion to an open operation . There was no difference in postoperative surgically related complications including wound infection , leakage , intestinal obstruction , postoperative ileus . Nonsurgical-related complications were also similar . The median time to resumption of a normal diet was 3 days and 4 days in the laparoscopic and open groups , respectively . The median hospital stay in patients with laparoscopic resection was significantly shorter than in patients with open surgery ( 6.0 days vs 7.0 days , P<0.001 ) . The 2-year overall survival rates were 74 % in both groups ( P=0.904 ) . In the converted to open ( LCOR ) group , the hospital stay was significantly longer ( LR vs OR vs LCOR , 5.5 days vs 7.0 days vs 9.0 days respectively , P<0.001 ) . Conclusion : Laparoscopic right hemicolectomy is a safe option for cancers of the right colon . It is associated with a shorter hospital stay and earlier resumption of a normal diet . Mortality and morbidity are similar to that with the open approach . There is no compromise in the survival of patients This study examined the impact of virtual reality ( VR ) surgical simulation on improvement of psychomotor skills relevant to the performance of laparoscopic cholecystectomy BACKGROUND It is not clear if robotically assisted surgery ( providing articulating instruments , 3-dimensional vision , intuitive ergonomics ) performed in pediatric patients offers the same advantages over conventional surgery as in adult patients . In the laboratory setting , robots require less time to perform certain tasks . Accordingly , we tested the hypothesis that the time required to perform a robot 
    Output:
    
Conclusions In the current literature , no firm consensus exists on the importance of haptic feedback in performing minimally invasive surgery .
Benefits are least disputed when related to surgery using robotics , because there is no haptic feedback in currently used robotics .
The addition of haptics is believed to reduce surgical errors result ing from a lack of it , especially in knot tying .
Concerning VR training , results indicate that haptic feedback is important during the early phase of psychomotor skill acquisition