***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 : To evaluate the safety and feasibility of single-incision laparoscopic cholecystectomy ( SILS-C ) compared with conventional laparoscopic cholecystectomy ( CLC ) . Methods : Sixty-five patients ( SILS-C : 35 , CLC : 30 ) were prospect ively enrolled and operated with conventional straight instruments . The postoperative pain scores at 6 , 24 hours , and 1 week , nausea , vomiting , commencement of oral intake , hospital stay , resumption of normal activities and work and satisfaction levels were noted . Results : Twenty-eight percent ( 10/35 ) SILS-C patients required introduction of additional trocars to complete the procedure . No patient required conversion to open . All the morbidity parameters were similar in both the groups , except that the seroma formation in the wound was significantly higher in the SILS-C group [ SILS-C : 17 % (6/35)/CLC : 0 % , P=0.038 ] . One patient in SILS-C had a major bile duct injury . Conclusions : SILS-C is safe and feasible with conventional instruments . However , caution needs to be exercised in view of a major bile duct injury and a higher rate of seroma formation in the wound BACKGROUND Single-incision surgery has gained in popularity , and the recent development of specialized robotic and laparoscopic instruments may remove some of the ergonomic and technical difficulties associated with this approach . However , questions of cost and efficiency remain . METHODS We prospect ively collected perioperative outcome and efficiency ( operative time , case volume ) data for our single-site robotic cholecystectomy cases and retrospectively review ed data for our single-incision laparoscopic cholecystectomy cases .  RESULTS There were no differences in patient characteristics or perioperative outcomes between the robotic ( n = 20 ) and laparoscopic ( n = 10 ) groups ;  operative times were equivalent ( 84.6 vs 85.5 min ; p = 0.8737 ) and blood loss and complications were minimal . There was a higher robotic case volume , with an average of two robotic cases ( range 1 - 4)/day vs one/day for laparoscopic cases ( range 1 - 1 ; p = 0.0306 ) . Streamlined instrument costs were essentially equivalent . CONCLUSIONS Robotic single-site cholecystectomy is a safe , cost-effective alternative to single-incision laparoscopic cholecystectomy in a robot-existing model Laparoscopic cholecystectomy ( LC ) is the gold-st and ard surgical method used to treat gallbladder diseases . Recently Laparoendoscopic single site surgery ( LESS ) has gained greater interest and diffusion for the surgical treatment of several pathologies . In elderly patients , just few r and omized controlled trials are present in the literature that confirm the clinical advantages of LESS compared with the classic laparoscopic procedures . We present in this paper the preliminary results of this r and omized prospect i ve study regarding the feasibility and safety of LESS cholecystectomy versus classic laparoscopic technique . We demonstrated that LESS technique compared with traditional technique show some advantages like : acceptable operative times , lower post-operative discomfort and sometimes reduction added complications . In addition we also demonstrate that fewer incisions and less scarring which mean less pain , and fewer parietal complications are related to this surgical procedure . In conclusion in the elderly  LESS cholecystectomy technique is to be considered a suitable alternative to traditional three-port cholecystectomy Abstract Background Surgeons continually strive to improve technology and patient care . One remarkable demonstration of this is the development of laparoscopic surgery . Once this proved to be a safe and reliable surgical approach , robotics seemed a logical progression of surgical technology . The aim of this project was to evaluate the utility of robotics in the context of single-incision laparoscopic cholecystectomy ( SILC ) . Methods A retrospective review of a prospect ively maintained data base of  robotic single-incision laparoscopic cholecystectomy ( RSILC ) and traditional SILC performed by a single surgeon at our institution from July 2010 to August 2013 was queried . All consecutive patients undergoing RSILC and SILC during this time period were included . Primary outcomes include conversion rate and operative time . Secondary outcomes include length of stay , duration of narcotic use , time to independent performance of daily activities and cost . Categorical variables were evaluated using Chi-square analysis and continuous variables using t test or Wilcoxon ’s rank test . Results Thirty-eight patients underwent RSILC and 44 underwent SILC .  BMI was higher in the RSILC group , and the number  of patients with prior abdominal surgeries was higher in the  SILC group . Otherwise , demographics were similar between the two groups . There was no difference in conversion rate between RSILC and SILC ( 8 vs 11 % , p = 0.60 ) . Mean operative time for RSILC was significantly greater compared with SILC ( 98 vs 68 min , p < 0.0001 ) . RSILC was associated with a longer duration of narcotic use ( 2.3 vs 1.7 days , p = 0.0019 ) and time to independent performance of daily activities ( 4 vs 2.3 days , p < 0.0001 ) . Total cost is greater in RSILC ( $ 8961 vs $ 5379 , p < 0.0001 ) . Conclusion While RSILC can be safely performed , it is associated with longer operative times and greater cost OBJECTIVES To report our results from a first human use clinical study with the da Vinci Surgical single-site instrumentation in patients with gallbladder disease and to perform a retrospective comparison with traditional multiport laparoscopic cholecystectomy . DESIGN Ten patients underwent robotic single-port cholecystectomy  performed with the da Vinci Si robot and novel da Vinci single-site instrumentation . Outcomes and operative times were compared with patients undergoing traditional multiport laparoscopic cholecystectomy during the same period . SETTING Tertiary care Veterans Administration hospital . PATIENTS Out patients older than 18 years with an American Society of Anesthesiologists class of 1 to 3 , no prior upper abdominal surgery , and diagnosis of noninflammatory biliary disease . INTERVENTION Single-site robotic cholecystectomy . MAIN OUTCOME MEASURES Operative time , complications up to 30 days , pain scores , and overall satisfaction . RESULTS Nine of 10 patients had completion of robotic single-site cholecystectomy . Average operating room time was 105.3 minutes compared with an average of 106.1 minutes in the st and ard laparoscopic group . There were no serious adverse events in the robotic surgery group , with an average follow-up of 3 or more months . CONCLUSION Robotic single-port cholecystectomy is feasible and comparable with st and ard laparoscopic cholecystectomy in the Veterans Administration medical center setting Background Single port cholecystectomy is increasingly performed . This procedure can be challenging , and we lack factors predicting the operative difficulty . Aims To assess the role of surgeon experience and identify possible predictive factors of intraoperative difficulties . Patients and methods Sixty-one selected patients were prospect ively enrolled between January 2008 and August 2010 . Six surgeons were involved ( 3 seniors , 3 juniors).Anthropometrics of the patients , types of ports , exposure methods and intraoperative data were recorded . Pain was assessed with the visual analogic scale at postoperative day 1 ( POD 1 VAS ) . Results Fifty-eight patients with symptomatic gallstones and three with acute cholecystitis underwent single port cholecystectomy .  The mean BMI , weight and height were 25.7 kg/m2 ( SD 4.45 ) , 71.8 kg ( SD 14.83 ) and 166 cm SD 0.07 , respectively . Mean operative time was 68.4 min ( SD 26.98 ) . Anthropometrics had no influence on operative time . Senior surgeons performed more rapidly , but the difference was not significant . The overall mean POD 1 VAS was 2.26 , ( SD 1.81 ) . The mean hospital stay was 2.22 days , ( SD 0.9 ) . No complications occurred . An additional exposure method was necessary in 19 procedures . This cluster presented a significantly higher operating time ( 81.5 min , SD 31.69 vs. 62.7 , SD 22.74 ; p = 0.01 ) and POD 1 VAS ( 1.92 vs. 3 ; p = 0.031 ) . ConclusionS ingle trocar cholecystectomy can be implemented safely in teaching hospitals . Anthropometrics are not predictive of operative difficulties . The need for additional exposure systems affects the operative time and pain negatively , reflecting greater technical difficulties . Research to optimize instruments may help to solve these problems Background The role of the human camera holder during laparoscopic surgery keeps valuable personnel from other duties . EndoAssist is a robotic cameraholding device controlled by the operator ’s head movements . This study assesses its introduction into clinical practice . Method Ninety-three patients undergoing laparoscopic cholecystectomy were r and omized to have either the  robotic ( 40 ) or a human (  46 ) assistant .  Seven patients converted to open operation were excluded . Six surgeons were evaluated .  Operating time and subjective assessment s were recorded . Learning curves were constructed . Results The mean operating time was less using the robotic assistant ( 66 min ) than with human assistance ( 74 . min ) ( p<0.05 , two-tailed t-test ) . The learning curves for operating time showed that within three operations surgeons were trained in using the robot . The device was safe in use . Conclusion The EndoAssist operating device is a significant asset in laparoscopic surgery and a suitable substitute for a human assistant . Surgeons became competent in the use of the robot within three operations . The robot offers stability and good control of the television image in laparoscopic surgery Background . Laparoscopic cholecystectomy is the st and ard treatment for symptomatic gallbladder disease .  Single‐incision laparoscopic surgery was developed with the aim of decreasing the invasiveness of conventional laparoscopy . The aim of this study was to compare the clinical outcome of single‐incision laparoscopic cholecystectomy with 3‐port laparoscopic cholecystectomy . Methods . From February 2014 to September 2016 , 187 patients with symptomatic cholecystolithiasis were r and omized to a single‐incision laparoscopic cholecystectomy group ( 89 patients ) or a 3‐port laparoscopic cholecystectomy group ( 98 patients ) . The primary outcomes were a postoperative pain score ( at 6 hours and 1 day ) and patients of complications , while the secondary outcomes were operative time , estimated blood loss , opioid requirements , duration of hospital stay , and patient satisfaction with aesthetic effects . Results . When comparing 3‐port laparoscopic cholecystectomy and single‐incision laparoscopic cholecystectomy , there were differences in the ( mean ± st and ard deviation ) operative time ( 58.9 ± 18.6 minutes vs 45.2 ± 11.8 minutes ; P < .001 ) , success rate ( 93 % vs 99 % ; P < .01 ) , conversion rate ( 7 % vs 1 % ; P < .001 ) , and aesthetic score ( 7.9 ± 1.6 vs 6.7 ± 1.4 ; P = .008 ) . There were no statistically significant differences in estimated blood loss , postoperative pain , opioid requirement , complications , and hospital stay between both groups . Conclusion . Single‐incision laparoscopic cholecystectomy is a safe and feasible procedure in selected patients . The main advantage is the superior aesthetic results , while the main disadvantage is a greater operative time with some technical difficulties 
    Output:
    
Conclusion : SIRC is a safe and feasible procedure for cholecystectomy , and the operative time is same as SILC , but the total cost of SIRC is significantly higher than SILC