The global robotic surgery market weighs 13.69 billion dollars in 2025. At the same time, 5 billion people — two-thirds of the world’s population — do not have access to affordable surgery, anesthesia, and obstetric care. The most promising medical innovation of the century is exacerbating geographic fractures instead of reducing them.
The surgical robot does not merely overcome technical obstacles; it materializes the abyss between those who live and those who die according to their birthplace. Each year, the current economic situation in healthcare and the cost of robotic surgery intensify inequalities in care. Only 2% of surgeries in Europe and 15% in the United States use robotic assistance, creating a two-speed medical system where technological innovation deepens disparities rather than bridging them.
North America Monopolizes Surgical Innovation
The United States hosts nearly 60% of all global robotic surgical installations, a concentration that reveals the ecosystem necessary for deploying these cutting-edge technologies. Intuitive Surgical’s da Vinci system has more than 5,000 global installations present in 69 countries, but innovations are primarily concentrated in major hospital centers, mainly located in North America, Western Europe, and Northern Asia.
Three factors explain Western dominance: advanced healthcare infrastructures, continuous research and development investments, and the presence of major market players. In the United States, 876,000 robotic interventions were performed in 2020, while 15.1% of hospitals with more than 500 beds have adopted these techniques.
Europe follows this dynamic with marked disparities. Germany has more than 180 da Vinci systems installed as of 2021, benefiting from developed healthcare infrastructures and favorable reimbursement policies that reduce costs for patients. But even in France, significant disparities and inequalities in access to robot-assisted surgery exist, with their consequences in terms of care supply and relevance.
Urology and Gynecology Lead Adoption
Adoption rates vary considerably depending on the interventions. Robotic prostatectomy reaches 87% adoption in 2019, hysterectomy 60.8% in 2018, while robotic inguinal hernia repair skyrocketed from 0.7% in 2012 to 28.8% in 2018.
In 2024, urology represents 27.44% of the global market, followed by gynecology with 31 billion dollars in 2023, projected to exceed 41 billion by 2026. Specialization is explained by the nature of the procedures: delicate interventions requiring millimeter precision, in restricted anatomical spaces.
The orthopedic segment is experiencing the fastest growth, due to the increasing number of joint replacement surgeries. In April 2025, Intuitive obtained FDA authorization for its SureForm 45 stapler intended for single-port robotic surgery in urology, while Medtronic submitted its Hugo system with 98.5% clinical success rate.
Emerging Asia Challenges Western Hegemony
China performed more than 100,000 robotic surgeries in 2022 alone, confirming Asian emergence. The introduction of robotic surgery aims to partially compensate for the shortage of medical personnel by optimizing the use of existing expertise. Robotic systems allow surgeons to intervene with increased precision and open the way to remote intervention models.
India has 66 centers dedicated to robot-assisted surgery, with 71 systems installed, used by 500 trained surgeons, totaling 12,800 interventions over 12 years. Brazil exceeded one hundred robotic platforms before 2025, with exponential growth in the number of procedures.
These figures mask, however, contrasting realities. Efforts are underway to develop more affordable robotic systems such as the SSi Mantra platform developed locally in India, explicitly designed to reduce acquisition and operating costs compared to Western platforms.
The Economic Chasm That Divides Access to Care
A robotic system costs between 1.5 and 2 million dollars, plus maintenance and training fees. The development of robot-assisted surgery is hindered by financing exclusively supported by healthcare institutions, a source of access inequalities for patients. Adding to this are 4,000 dollars per intervention, creating insurmountable obstacles despite growing demand.
Small facilities or underserved territories can scarcely invest, with a risk of territorial fracture in terms of innovation. The example of Amor Hospital in Brazil illustrates these challenges: despite acquiring a da Vinci system in 2013, the hospital faced a one-year delay in its implementation due to high maintenance costs, estimated at 3.5 million reais over 10 years.
In low and middle-income countries, where surgical personnel are 70 times fewer than in high-income countries — 1 specialized doctor per 100,000 inhabitants versus more than 70 in wealthy countries, robotic systems are frequently installed in the private sector or in major cities, aggravating health inequalities.
Without policies for internalization and professional training, the risk is perpetuating regional inequalities in a new technological form. These surgeries are invariably offered to affluent populations, perpetuating the vicious cycle of socioeconomic fracture.
Training and Skills: The Challenge of Technological Transition
Becoming competent in robotic surgery requires specialized training and significant commitment in time and effort. Surgeons must acquire the skills to effectively operate robotic systems, navigate the surgical console, and precisely manipulate robotic instruments.
Training is not standardized in surgical practice, increasing the risk of medical errors and compromising patient safety in countries that do not provide adequate training. While 5G technology can reduce telesurgery delays, its implementation may take another 3 to 5 years in low-income countries.
Recent advances such as remote telesurgery may possibly help bridge the gap, but it is estimated that a delay of 300 milliseconds is the maximum delay compatible with safe robotic surgery, often compromised in areas with poor network connectivity.
Artificial Intelligence Redefines Robotic Surgery
Surgical robots are increasingly integrating with artificial intelligence, making it possible to streamline surgical procedures. AI-assisted robotic surgeries demonstrate a 25% reduction in operative time and a 30% decrease in intra-operative complications compared to manual methods. Surgical precision improves by 40%, reflected in better targeting precision during tumor resections and implant placements.
The integration of the wireless network system with robotic technology has led to the emergence of telesurgery where surgeons oversee robotic surgery remotely. Telesurgery reshuffles geographic maps and poses new challenges to medical sovereignty.
Accessibility, an Impossible Promise?
Optimization strategies for use (platform sharing, robot leasing, public-private partnerships) are emerging in response to these constraints. The incorporation of robotic surgery into the healthcare system could help reduce global surgical disparities, but reality is grimmer.
The poorest third of the world’s population benefits from only 6% of recorded interventions globally, while in low-income countries, nine out of ten people are exposed to the risk of impoverishment due to direct payments for surgical care.
Since April 1, 2026, robotic prostatectomy surgery is mandatorily covered by health regimes in Brazil. For the first time, a highly complex surgical technology ceases to be the privilege of a few and formally enters the realm of social rights. But this advance concerns only one intervention, in a single country.
The contradiction lies at the heart of globalized health systems: the more technology progresses, the more it widens the gap between those who access it and those excluded from it. The future of robotic surgery is no longer being decided in laboratories but in political choices that will determine whether it will save lives everywhere or only in wealthy countries.