Hospital costs and procedural learning curves of robotic mitral valve surgery: a systematic review and meta-analysis

Robotic-assisted mitral valve surgery offers a less invasive alternative to traditional open sternotomy, with potential benefits including faster recovery and reduced morbidity. However, the higher upfront expenses have slowed its broader acceptance. This study aimed to synthesize existing evidence comparing robotic and conventional mitral valve procedures regarding overall hospital expenses, intraoperative and post-procedure costs, as well as learning trajectory parameters including aortic cross-clamp and cardiopulmonary bypass durations. A systematic search of PubMed, Scopus, Web of Science, and the Cochrane Library was conducted up to May 2026 to identify studies reporting cost or learning curve outcomes. A random-effects model with restricted maximum likelihood estimation was used in R software for all pooled analyses. Seventeen studies met inclusion criteria. Total hospital costs from five studies (91,541 participants) showed no significant difference between approaches (MD + 1,620 USD; p = 0.423) with high heterogeneity (I² = 99.3%). Leave-one-out analysis excluding one large US database study demonstrated significantly lower total costs for robotic surgery (p < 0.001) with no heterogeneity. Robotic procedures had higher intraoperative costs (MD + 2,144 USD; p < 0.001) but lower postoperative costs (MD -556 USD; p < 0.001). The learning phase trended toward longer cross-clamp and bypass times versus proficiency, with no differences between proficiency and mastery phases. Robotic mitral surgery demonstrated no significant difference in total hospital costs compared with conventional approaches in the primary analysis, with higher intraoperative costs offset by lower postoperative expenses. However, substantial heterogeneity and limited learning curve evidence prevent definitive conclusions. Future studies should adopt standardized economic and learning curve methodologies.