The exponential use of robotic surgery is not the result of evidence-based benefits but mainly driven by the manufacturers, patients and enthusiastic surgeons. The present review of the literature shows that robot-assisted surgery is consistently more expensive than video-laparoscopy and in many cases open surgery. The average additional variable cost for gynecological procedures was about 1600？USD, rising to more than 3000？USD when the amortized cost of the robot itself was included. Generally most robotic and laparoscopic procedures have less short-term morbidity, blood loss, intensive care unit, and hospital stay than open surgery. Up to now no major consistent differences have been found between robot-assisted and classic video-assisted procedures for these factors. No comparative data are available on long-term morbidity and oncologic outcome after open, robotic, and laparoscopic gynecologic surgery. It seems that currently only for very complex surgical procedures, such as cardiac surgery, the costs of robotics can be competitive to open surgical procedures. In order to stay viable, robotic programs will need to pay for themselves on a per case basis and the costs of robotic surgery will have to be reduced. 1. Introduction The use of robotic assisted surgery has grown exponentially over the last few years as there is a clear trend in surgery, driven by patient demand, to develop less invasive approaches to common procedures [1–7]. Robotic technology has gained popularity in various surgical specialities such as urology, gynecology, thoracic surgery, general surgery, and currently head and neck surgery. The Da Vinci Surgical system is the only FDA-approved robotic system currently on the market [2, 6, 8]. Robot-assisted and laparoscopic surgery eliminates the need for large morbid and less esthetical incisions and often decreases blood loss, postoperative pain, use of pain medication, and length of hospital stay [2, 6]. Advantages of robotic surgery compared to laparoscopy and open surgery are improved dexterity, more precise movements and tremor reduction, and better visualization of the operating field (magnification and 3D). In addition, the robot fingertip hand control mechanism is “intuitive,” meaning that the robotic instruments will move just as your hands move, rather than as a mirror image movement as in laparoscopy [8]. The robotic digital process allows scaling down the surgeons’s hand movements to a level at which microvascular or microscopic procedures are feasible. Difficult, minimal invasive surgery is accessible for surgeons without
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