Outcomes Analyses
Dr. Mitzman pointed to the COMPARE Study, a systematic review of outcomes from robotic surgery versus laparoscopic or video-assisted thoracoscopic or open oncologic surgery across seven procedures, including lobectomy, hysterectomy, and low anterior resection.1 The results showed that robotic surgery led to shorter lengths of stay, fewer complications, and a much lower risk of conversion to open surgery compared with laparoscopic or thoracoscopic approaches.
Similar findings can be seen for enhanced recovery and lower risk of conversion versus laparoscopy in other specialties as well, including numerous general surgery procedures.2
Looking specifically at cholecystectomy—a procedure that is often studied in this context due to its ubiquity and for which the laparoscopic approach has long been the “gold standard”—many studies point to positive outcomes for patient recovery and length of stay.3
However, it is important to note that drawing firm conclusions about the efficacy of robotic-assisted surgery from different studies has some inherent hurdles since the research goals may be different.
“When you’re assessing whether or not robotics is better than laparoscopy or open surgery, we need to ask, what is the comparison, what is the population and the specific disease you’re dealing with, and then what outcome do you care about?” explained Christopher Childers, MD, PhD, assistant professor of hepatopancreatobiliary surgery at the University of Washington and Fred Hutch Cancer Center in Seattle.
“There have been a lot of high-profile trials that have been published in well-reviewed journals that are comparing different buckets of outcomes, from short-term outcomes such as length of stay or complications rates to long-term outcomes like survival, which are particularly germane for surgical oncology,” he added.
What this means is that while one can make observations that robotic surgery is showing encouraging results compared to other modalities, studies and data points still need to be aligned to draw definitive conclusions.
Considerable Up-Front Costs?
It seems clear that there is broad agreement that robotic surgery can be effective and safely applied to many procedures. But even in studies that are supportive of the technology, many include a similar caveat: robotic surgery is associated with higher healthcare costs compared with other types of minimally invasive surgery.4
While implementing a robotic surgery platform into a hospital can be expensive, analyzing current cost models is more complex than simply comparing the price of a surgical robot or a laparoscopy tower.
There is no doubt that there may be an eye-catching cost to buy a surgical robot. Intuitive’s da Vinci 5, for example, is the latest release from the largest surgical robotic manufacturer and has a price of $1.8 to $2.5 million. Older products from Intuitive, as well as other manufacturers, routinely sell for hundreds of thousands of dollars to more than $1 million.5 An up-front price like that would be a significant addition to any hospital’s budget and may limit accessibility—however, new pricing models are softening that initial financial blow.
“Historically, the capital cost of building or expanding a robotic program involved buying a robot for $2 million or leasing it with significant up-front costs, but now manufacturers are offering a ‘pay-per-click model,’ where there really is little capital investment up front,” said Dr. Mitzman, who has overseen a significant expansion of the robotic surgery fleet in the University of Utah Health System.
The cost of the unit is spread out over the purchase contract and the number of cases being performed, so the hospital system will pay a fee every time a robotic case is completed.
“They are essentially amortizing the cost of the robot over 7 years, and however many thousands of cases they expect you to do. So, it’s much easier for a system to expand rapidly with little cost up front,” he said, which significantly increases the ability of smaller or rural hospitals to install a unit.
In this system, the initial hurdle of purchasing a system is lowered—which is mutually beneficial to the hospital as it gains access to the platform, but also to the manufacturer as the rate of new surgical robots sold inevitably slows in the future.
“Hospitals can only install so many robots,” Dr. Childers said. “The bulk of spending on robotics is now on recurring costs, not the cost of the machine itself. Something like 85% of the Intuitive’s revenue is now recurring, primarily from purchasing the instruments, because those are effectively disposable. You can use them for 10 times, maybe 18 times, but then you need to buy them again.”
Both the up-front costs and subsequent operating costs also could decrease as competition increases.
Estimating Direct Operating Costs
The need to replace instruments and the cost of doing so inevitably leads to the prima facie financial point of concern for robotic surgery—the direct cost to perform a robotic procedure versus another approach.
The data here also are in their nascent stages. One study looked at hospitalization costs and found that robotic abdominal procedures incur an average additional cost of more than $2,000 compared to laparoscopic,6 which provides a quantifiable figure for analysis.
One potential way of estimating direct costs is by starting at the foundation. Dr. Childers coauthored an article in 2018 that looked at the revenue generated by Intuitive in 2017—which, by definition, is the amount of money spent by hospitals to purchase and utilize the company’s robotic surgery platform—and found that Intuitive robots were used to perform 644,000 procedures in the US that created $2.3 billion in revenue domestically.
Dividing revenue by the number of operations results in a figure of nearly $3,600, the “absolute floor” of robotic surgery costs per procedure in the OR.7 Estimates from around the same time, place the disposable costs of a laparoscopic cholecystectomy, for example, at less than $1,000 per case.
For more recent numbers, Dr. Childers reviewed Intuitive’s 2024 data and found its robots were used to perform 1.7 million operations and made $5.6 billion in revenue, creating a figure of approximately $3,300 per case.8 These results suggest possibly small reductions in cost over time, although Dr. Childers cautioned that this “could just be reflecting a move toward a higher volume of simpler operations, such as appendectomy and cholecystectomy,” Dr. Childers said.
Both the up-front costs and subsequent operating costs also could decrease as competition increases. For example, in December 2025, Medtronic’s Hugo robotic system received US Food and Drug Administration clearance to be sold to hospitals, marking a potential major shift in the market.
At this point, it is worth noting that while the cost of robotic equipment and infrastructure are a regular part of the conversation in the finances of surgery, laparoscopy and other approaches also continue to incur a less discussed financial cost, Dr. Mitzman said. Laparoscopic towers, service contracts, and electrocautery generators may be considered a standard part of a budget after decades of regular use, but they, too, need to be included in any formal cost analysis of equipment acquisition.
Still, it appears that robotic surgery does incur additional costs to the hospital compared to other minimally invasive options. The direct costs also are complicated by inconsistent or nonexistent reimbursement models for robotic-assisted surgery.
“There is no payer or insurer that is paying more for robotic surgery over laparoscopic surgery, either to the physician or to the hospital. So, any math that a hospital will use as a basis for investing into and buying a robotic platform cannot be purely based on a revenue argument,” Dr. Childers said.
Can Indirect Costs Balance Economic Considerations?
While consensus holds that the direct costs of robotic-assisted surgery are higher than other alternatives for an index operation, evidence and surgeon experience indicates that a robotic approach to some procedures can lower downstream costs that are integral to balancing the economic bottom line.
Precise assessment varies across procedures and disciplines, but a common throughline in much of the literature on robotic-assisted surgery is that it often provides a reduced length of stay and a lower rate of complications.
If a surgeon can get a patient out of the hospital sooner, that translates into real value to the hospital, according to Dr. Childers.
“Hospitals are almost uniformly paid a fixed rate for hospitalization. Medicare reimbursement is based on a Diagnosis-Related Group system or the Ambulatory Payment Classifications system, so they’re going to get a fixed rate for a gallbladder surgery or for a pancreas surgery. So, if you can get a patient out of the hospital a day sooner, and all the associated costs to the hospital of that hospitalization are therefore decreased, be it labs, imaging, or nursing care, those are all savings to the hospital system,” he said.
In addition, the cost of surgical complication itself can double hospitals costs.9 But the most significant impact may come from preventing conversion.
“One of the major things we’re finding from all these studies is, if you look at nothing else, the rate of conversion to open is substantially lower with robotic surgery than laparoscopy,” Dr. Mitzman said, noting that converting creates a much higher cost to the hospital system, payer, and patient, who also will experience more pain, a longer recovery, and a higher chance of morbidity and mortality.10
He suggested that the increased risk for conversion should be factored into any cost-benefit analysis of adding a robotic surgery option in a hospital.
Not surprisingly, the balance of direct costs and indirect costs is going to be specific to each procedure, and demonstrating the clinical and subsequent economic benefit of robotic-assisted surgery for certain well-established procedures could prove to be more difficult, particularly when the traditional minimally invasive approach is already deemed to be of high quality.
“Any incremental quality improvement needs to be assessed in comparison to the cost to get that quality improvement. And the challenge is when we start to introduce robotic technology where it’s really hard to move the needle on quality,” Dr. Childers said.
“If you already have an operation like laparoscopic cholecystectomy or laparoscopic appendectomy, which have excellent outcomes—most patients go home the same day with very low risk of complications—showing quality improvement with those high-quality standards is going to be hard; any incremental benefit is going to be low,” he said.
If you go from 1 in 1,000 to 1 in 2,000 operations incurring a complication, Dr. Childers said, a hospital will need to provide 1,000 additional operations in order to prevent one complication. When adding the higher direct costs of implementation and instruments for a robot, there could be a higher monetary cost to avert rare complications.
Surgeon and Patient Preference Play a Role
Analyzing the direct and indirect costs or cost savings related to robotic-assisted surgery are undoubtedly the cornerstone of a cost-benefit analysis for a hospital, but there are other economic dimensions to consider that drive revenue and may balance the equation.
How is robotic-assisted surgery increasingly being adopted by hospitals and surgeons, growing exponentially in use over the past decade, even as definitive evidence demonstrating clinical benefits continues to elude researchers?
The answer is multivariate, but the fact remains that many surgeons want to use a robot in their practice, which means hospital systems will need to reconsider their approach to workforce retention and recruitment.
Because many current mid- and later-career surgeons completed additional training on a surgical robot and have shown encouraging results, the preference for robotics is firmly taking root during contemporary training—an inclination that may be further strengthened because of the easier transference of open surgery skills to the robotic approach.
“We’re in an era where most of our residents in general surgery and the surgical subspecialties are coming into practice with robotic training. If anything, if they want to do laparoscopic surgery, they may need to complete extra, external training in laparoscopy,” Dr. Mitzman said.
Robotic proficiency may become a standard expectation for both hiring hospitals and surgeons seeking employment.
“Surgeons are coming out of training wanting to use the robot. If you’re trying to recruit for a certain position, and you’re not going to provide a robotic platform, you’re going to substantially limit your applicant pool,” Dr. Mitzman said.
A hospital may try to save on costs by choosing not to invest in a fleet of robotic devices, but if they are unable to hire one of the increasing number of surgeons seeking to use a robot, they risk losing a considerable source of income.
Hospitals also risk losing revenue if surgeons develop musculoskeletal injuries, which are frequently caused by the demanding positions and angles required in laparoscopic procedures.11
“One of the possible benefits of the robot for surgeons is in its improved ergonomics. One question that surgeons need to ask themselves is, am I less likely to develop neck and back pain or end up having to go out on disability because I’m able to use the robot, as opposed to doing laparoscopy or open surgery?” Dr. Childers added.
Surgeons are central in driving adoption and access to any operative technology, but as surgical robots and their potential to provide easier recovery becomes more ubiquitous, patients themselves are now becoming important factors in compelling hospitals to procure surgical robots.
“For better or for worse, the robotics companies have done an amazing job marketing robotics to patients. They are coming to the hospital, to surgeons, saying, ‘I will only have this operation robotically,’” Dr. Mitzman said. “And I’m not here to argue whether that’s right or wrong, but if you don’t have the ability to provide a robotic-assisted approach, you’re going to limit your market share and your ability to provide an operation to your community.”
Ultimately, the true bottom line regarding the relative costs of robotic surgery is still being written. This is a topic that has many inputs—both in data and surgeon experience—and new realms of “cost” continue to come into focus. For example, some findings suggest that robotic surgery has a higher environmental cost in terms of greenhouse gas emissions, compared to other minimally invasive approaches.12
It is incumbent upon surgeons to be aware of the many cost dimensions of robotic surgery so they can be a leading voice in helping their hospitals and the field advance toward the surgical approach that will produce the best outcomes and meet the needs of their patients.
Matthew Fox is the Digital Managing Editor in the ACS Division of Integrated Communications in Chicago, IL.
References
- Ricciardi R, Seshadri-Kreaden U, Yankovsky A, et al. The COMPARE study: Comparing perioperative outcomes of oncologic minimally invasive laparoscopic, da Vinci robotic, and open procedures: A systematic review and meta-analysis of the evidence. Ann Surg. 2025;281(5):748-763.
- Gangemi A, Ebadinejad A, Lisi AP, et al. The CONVERSION study: Open conversion risk in robotic vs laparoscopic surgery—A 20-year meta-analysis. Ann Surg. Published online November 14, 2025.
- Maegawa FB, Stetler J, Patel D, et al. Robotic compared with laparoscopic cholecystectomy: A National Surgical Quality Improvement Program comparative analysis. Surgery. 2025;178:108772.
- Lai TJ, Roxburgh C, Boyd KA, Bouttell J. Clinical effectiveness of robotic versus laparoscopic and open surgery: An overview of systematic reviews. BMJ Open. 2024;14(9):e076750.
- How Much is a Surgical Robot? (2025 Edition). R2 Surgical. 2025. Available at: https://r2surgical.com/blogs/x-and-xi-robots/how-much-is-a-surgical-robot-2025-edition. Accessed January 20, 2026.
- Ng AP, Sanaiha Y, Bakhtiyar SS, Ebrahimian S, et al. National analysis of cost disparities in robotic-assisted versus laparoscopic abdominal operations. Surgery. 2023;173(6):1340-1345.
- Childers CP, Maggard-Gibbons M. Estimation of the acquisition and operating costs for robotic surgery. JAMA. 2018;320(8):835-836.
- Intuitive Announces Preliminary Fourth Quarter and Full Year 2024 Results | Intuitive Surgical. Intuitive Surgical. 2024. Available at: https://isrg.intuitive.com/news-releases/news-release-details/intuitive-announces-preliminary-fourth-quarter-and-full-year-4. Accessed January 20, 2026.
- Watson SL, Fowler AJ, Pearse RM, Abbott TEF. The financial cost of postoperative complications: A prospective cohort study with linked health systems data. Br J Anaesth. 2025;135(6):1753-1760.
- Shah AA, Bhatti UF, Petrosyan M, et al. The heavy price of conversion from laparoscopic to open procedures for emergent cholecystectomies. Am J Surg. 2019;217(4):732-738.
- McCartney J. “Smarter Tools, Culture Shift Are Reshaping Surgical Ergonomics.” Bulletin of the American College of Surgeons. December 2025. Available at: https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/bulletin/2025/november-december-2025-volume-110-issue-10/smarter-tools-culture-shift-are-reshaping-surgical-ergonomics/. Accessed January 20, 2026
- Zhang X, Wang J. Comments on: "The environmental impact of multi-specialty robotic-assisted surgery: a waste audit". J Robot Surg. 2025;19(1):194.
