It is imperative for organizations to understand what the cost of performing robotic surgery is as compared to traditional surgery. Armed with this data organizations can evaluate resource allocation and utilization in the enterprise. Unfortunately most of these studies are published in the non-head and neck surgery literature, but the costing can be pertinent to our specialty.

Recently an article evaluating 24,312 radical nephrectomies of which 7,787 were performed robotically was published comparing the costs between laparoscopic and robotic surgery [1]. This study showed median total hospital costs for robotic assisted surgery were $15,149 compared to $11,735 for laparoscopic surgery (p < 0.001). There was no difference in perioperative complications or the incidence of death. Another study [2] has shown that robotic surgery is safer than laparoscopic surgery. In this study Yu et al. showed that robotic assisted laparoscopic surgery and laparoscopic surgery versus open surgery were associated with shorter length of stay for all procedures, with robotic assisted laparoscopic surgery being the shortest for radical prostatectomy and partial nephrectomy (all p < 0.001). For most procedures robotic assisted laparoscopic surgery and laparoscopic surgery versus open surgery resulted in fewer deaths, complications, transfusions, and more routine discharges. Safety of a procedure does play into overall costs in an institution. Lower number of blood transfusions may lead to fewer ICU stays and hence reduce the overall cost of admission.

Robotic applications in Gynecology have also been reviewed. A study by Barnett et al. on management of endometrial cancers [3] showed that laparoscopy is the least expensive surgical approach for the treatment of endometrial cancer. Robotic surgery is less costly than abdominal hysterectomy when the societal costs associated with recovery time are accounted for and is most economically attractive if disposable equipment costs can be minimized to less than $1,496 per case.

Since robotic surgery can have a cost burden to the healthcare system it has been studied by national health care systems. One such study using data from the Japanese National Health Insurance System (JNHIS) showed that only institutions which perform more than 300 robotic operations per year would obtain a positive cost benefit performance and avoid financial deficit with the projected JNHIS reimbursement [4]. The hope is that a reduction in price of robotic equipment by the manufacturer would result in a decrease in the cost per procedure.

Recently a European study looked at costing data comparing total laryngectomy with transoral laser microsurgery (TLM) and transoral robotic surgery (TORS) [5]. This study showed that the total cost for supraglottic open (135–203 min), TLM (110–210 min), and TORS (35–130 min) approaches were 3,349€ (3,193–3,499€), 3,461€ (3,207–3,664€), and 5,650€ (4,297–5,974€), respectively. For total laryngectomy, the overall costs were 3,581€ (3,215–3,846€) for open and 6,767€ (6,418–7,389€) for TORS. TORS cost is mostly influenced by equipment (54 %) where the other procedures are predominantly determined by personnel cost (about 45 %). The authors concluded that TORS is more expensive than standard approaches and mainly influenced by purchase and maintenance costs and the use of proprietary instruments.

Kang et al used the da Vinci to treat 338 patients with thyroid cancer with total (n = 104) and subtotal (n = 234) thyroidectomies using endoscopic thyroid surgery with a gasless transaxillary approach. They reported a mean operating time of 144 min with a mean postoperative hospital stay of 3.3 days [6]. In contrast, another Korean study presented a series of 52 patients who underwent non-robotic endoscopic hemithyroidectomy with a gasless transaxillary approach. They reported a mean operating time of 154 ± 68 min with a mean postoperative hospital stay of 6.37 ± 2.83 days [7]. Thereby reducing the OR and inpatient cost manifold. Emerging evidence suggests that the longer operating times attributable to a steep learning curve will reduce with experience in the use of the robot.