Comparative Cost Analysis of Robotic Surgical Platforms: A Cost-Minimization and Break-Even Analysis

Over the past two decades, robotic surgery has witnessed a rapid and widespread adoption across almost all surgical specialties, with the da Vinci Surgical System (Intuitive Surgical) emerging as the dominant platform worldwide. Its technological advantages—such as improved ergonomics, precision, and minimally invasive access—have contributed to its success. However, the substantial costs associated with acquisition, maintenance, and disposable instruments represent a significant limitation, especially in public healthcare systems. In recent years, new robotic platforms have entered the market with the explicit goal of improving cost-effectiveness while maintaining comparable clinical performance. This study aims to conduct a comprehensive economic evaluation of three robotic surgical platforms currently in use at ASST Grande Ospedale Metropolitano Niguarda Hospital, through a cost-minimization analysis and break-even point calculation. Cost data were collected from the hospital's internal management system and supplemented with published literature to ensure a realistic and robust estimation of direct and indirect costs. A deterministic sensitivity analysis was applied, varying key parameters—such as number of surgeons, number of instruments, and procedure duration—within predefined ranges to assess the variability of outcomes under different assumptions. This allowed the identification of threshold values and critical cost drivers that influence the economic sustainability of each system. The results of this analysis provide valuable insights into the comparative cost-efficiency of the platforms evaluated and may guide hospital administrators and policymakers in making informed decisions regarding the adoption and allocation of robotic surgical technologies. By integrating real-world data with economic modelling, this study contributes to the growing body of evidence aimed at optimizing the value of innovation in surgical practice.