Robotic Surgery in Gynecology: Balancing Clinical Benefit, Cost-Effectiveness, and Accessibility

Background: Robotic-assisted surgery (RAS) has progressively expanded in gynecologic practice. Although its technical advantages are recognized, its economic sustainability and equitable accessibility remain debated. Methods: This clinical update provides a critical narrative review of current evidence on RAS in gynecology, integrating data on clinical outcomes, cost-effectiveness, diffusion patterns, and health equity across different healthcare settings. Results: In both benign and oncologic indications, RAS demonstrates consistent perioperative advantages over open surgery, including reduced blood loss, shorter hospital stay, and lower conversion rates. In routine cases, outcomes are largely comparable to conventional laparoscopy. However, robotic approaches appear particularly beneficial in complex scenarios, such as obesity, advanced malignancy, and technically demanding procedures. Economic evidence is heterogeneous. Short-term hospital-based studies report higher direct costs for RAS, especially in benign surgery. Conversely, cost-utility models in oncologic settings suggest that RAS may achieve acceptable cost-effectiveness when long-term outcomes, quality-adjusted life years, and institutional volume are considered. Accessibility remains strongly influenced by reimbursement policies, procedural volume, infrastructure, and workforce training. In the absence of structured reimbursement frameworks, robotic surgery may contribute to socioeconomic and geographic disparities. Conclusions: RAS represents an important component of modern gynecologic surgery, particularly in high-complexity and high-risk cases in which its technical advantages may translate into meaningful perioperative benefit. Its long-term sustainability depends on appropriate patient selection, institutional volume, reimbursement models, and health system organization. Future research incorporating long-term and societal economic perspectives is required to support balanced and equitable implementation.