***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 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 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 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 Background The aim of this study was to examine the advantages and risks of the Automated Endoscopic System for Optical Positioning ( AESOP ) 3000 robot system during uncomplicated laparoscopic cholecystectomies or laparoscopic hernioplasty . Methods In a r and omized study , we examined two groups of 120 patients each with the diagnosis cholecystolithiasis respectively the unilateral inguinal hernia . We worked with the AESOP 3000 , a robotic arm system that is voice-controlled by the surgeon . The subjective and objective comfort of the surgeon as well as the course and length of the operation were measured . Results The robot-assisted operations required significantly longer preparation and operation times . With regard to the necessary comm and s and manual camera corrections , the assistant group was favored . The same was true for the subjective evaluation of the surgical course by the surgeon . Conclusions Our study showed that the use of AESOP during laparoscopic cholecystectomy and hernioplasty is possible in 94 % of all cases . The surgeon must accept a definite loss of comfort as well as a certain loss of time against the advantage of saving on personnel Abstract Background R and omized studies could not demonstrate significant outcome benefit after single-incision laparoscopic cholecystectomy compared to classic four-port laparoscopic cholecystectomy ( CLC ) . The new robotic single-site platform might offer potential benefits on local inflammation and postoperative pain due to its technological advantages . This prospect i ve r and omized double-blind trial compared the short-term outcomes between single-incision robotic cholecystectomy ( SIRC ) and CLC . Methods Two groups of 30 eligible patients were r and omized for SIRC or CLC .  During the first postoperative week , patients and study monitors were blinded to the type of procedure performed by four dressing tapes applied on the abdomen . Pain was assessed at 6 h and on day 1 , 7 and 30 after surgery , along with a 1–10 cosmetic score . Results No significant difference in postoperative pain occurred in the two groups at any time point nor for any of the abdominal sites . Nineteen ( 63 % ) SIRC patients reported early postoperative pain in extra-umbilical sites . Intraoperative complications which might influence postoperative pain , such as minor bleeding and bile spillage , were similar in both groups and no conversions occurred . The cosmetic score 1 month postoperatively was higher for SIRC ( p < 0.001 ) . Two SIRC patients had wound infection , one of which developed an incisional hernia . Conclusions SIRC does not offer any significant reduction of postoperative pain compared to CLC . SIRC patients unaware of their type of operation still report pain in extra-umbilical sites like after CLC . The cosmetic advantage of SIRC should be balanced against an increased risk of incisional hernias and higher costs . Trial registration numberACTRN12614000119695 ( http://www.anzctr.org.au ) Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background : Laparoscopic surgery might be beneficial for the patient , but it imposes increased physical and mental strain on the surgeon . Robot-assisted laparoscopic surgery addresses some of the laparoscopic drawbacks and may potentially reduce mental strain . This could reduce the risk of surgeon 's fatigue , mishaps and strain-induced illnesses , which may eventually improve the safety of laparoscopic surgical procedures . Methods : To test this hypothesis , a r and omized study was performed , comparing both heart rate and heart rate variability ( HRV ) of the surgeon as a measure of total and mental strain , respectively , during  conventional and robot-assisted laparoscopic cholecystectomy .  Results : Both heart rate and HRV ( the low-frequency b and /high-frequency b and ratio ) were significantly decreased when using robotic assistance . Conclusions : These data suggest the use of the daVinci ® Surgical System leads to less physical and mental strain of the surgeon during surgery . However , assessing mental strain by means of HRV is cumbersome since there is no clear cutoff point or scale for maximum tolerated strain levels and its related effects on surgeon 's health Background Recent advances in robotic technology suggest that the utilization of the da Vinci Single-Site ™ platform for cholecystectomy is safe , feasible and results in a shorter learning curve compared to conventional single-incision laparoscopic cholecystectomy . Moreover , the robot-assisted technology has been shown to reduce the surgeon ’s stress load compared to st and ard single-incision laparoscopy in an experimental setup , suggesting an important advantage of the da Vinci platform . However , the above-mentioned observations are based solely on case series , case reports and experimental data , as high- quality clinical trials to demonstrate the benefits of the da Vinci Single-Site ™ cholecystectomy have not been performed to date . Methods This study addresses the question whether robot-assisted Single-Site ™ cholecystectomy provides significant benefits over single-incision laparoscopic cholecystectomy in terms of surgeon ’s stress load , while matching the st and ards of the conventional single-incision approach with regard to peri- and postoperative outcomes . It is design ed as a single centre , single-blinded r and omized controlled trial , which compares both surgical approaches with the primary endpoint surgeon ’s physical and mental stress load at the time of surgery . In addition , the study aims to assess secondary endpoints such as operating time , conversion rates , additional trocar placement , intra-operative blood loss , length of hospital stay , costs of procedure , health-related quality of life , cosmesis and complications . Patients as well as ward staff are blinded until the 1st postoperative year . Sample size calculation based on the results of a previously published experimental setup utilizing an estimated effect size of surgeon ’s comfort of 0.8 ( power of 0.8 , alpha-error level of 0.05 , error margin of 10–15 % ) result ed in a number of 30 r and omized patients per arm . Discussion The study is the first r and omized controlled trial that compares the da Vinci Single Site ™ platform to conventional laparoscopic approaches in cholecystectomy , one of the most frequently performed operations in general surgery . Trial registration This trial is registered at clinical trials.gov ( trial number : NCT02485392 ) . Registered February 19 , 2015 Objective : To compare safety and costs of robotic-assisted and laparoscopic cholecystectomy in patients with symptomatic cholecystolithiasis . Background : Technical benefits of robotic-assisted surgery are well documented . However , pressure is currently applied to decrease costs , leading to restriction of development , and implementation of new technologies . So far , no convincing data are available comparing outcome or costs between computer assisted and conventional laparoscopic cholecystectomy . Methods : A prospect i ve case-matched study was conducted on 50 consecutive patients , who underwent robotic-assisted cholecystectomy ( Da Vinci Robot , Intuitive Surgical ) between December 2004 and February 2006 . These patients were matched 1:1 to 50 patients with conventional laparoscopic cholecystectomy , according to age , gender , American Society of Anesthesiologists score , histology , and surgical experience . Endpoints were complications after surgery ( mean follow-up of 12.3 months [ SD 1.2 ] ) , conversion rates , operative time , and hospital costs ( Clinical Trial.gov ID : NCT00562900 ) . Results : No minor , but 1 major complication occurred in each group ( 2 % ) . No conversion to open surgery was needed in either group . Operation time ( skin-to-skin , 55 minutes vs. 50 minutes , P < 0.85 ) and hospital stay ( 2.6 days vs. 2.8 days ) were similar . Overall hospital costs were significantly higher for robotic-assisted cholecystectomy $ 7985.4 ( SD 1760.9 ) versus $ 6255.3 ( SD 1956.4 ) , P < 0.001 , with a raw difference of $ 1730.1(95 % CI 991.4–2468.7 ) and a difference adjusted for confounders of $ 1606.4 ( 95 % CI 1076.7–2136.2 ) . This difference was mainly related to the amortization and consumables of the robotic system . Conclusions : Robotic-assisted cholecystectomy is safe and , therefore , a valuable approach . Costs of robots , however , are high and do not justify the use of this technology considering the lack of benefits for patients . A reduction of acquisition and maintenance costs for the robotic system is a prerequisite for large-scale adoption and implementation Abstract Background Surgeons continually strive to improve technology and 
    Output:
    
Conclusions The RAC was not found to be more effective or safer than LC for benign gallbladder diseases , which indicated that RAC is a developing procedure instead of replacing LC at once .
Given the higher costs , the current evidence is in favor of LC in cholecystectomy