Financial Viability of Robotic Surgery Programs Across Health Systems: Implementation Gaps in Low- and Middle-Income Countries

Introduction: Robotic surgery has expanded rapidly worldwide, but its financial viability remains highly dependent on health-system structure, reimbursement mechanisms, surgical volume, and institutional capacity. Access remains particularly limited in low- and middle-income countries. Compare the global implementation of robotic surgery programs and their financial sustainability models, and identify the main obstacles in low- and middle-income countries. Methods: A narrative review was conducted using PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar for English-language articles published between 2015 and 2026. Twenty-four studies were included and synthesized thematically. Results: The financial viability of robotic surgery is determined by acquisition costs, maintenance contracts, disposable instruments, operating room efficiency, case volume, reimbursement models, and multi-specialty use. High-income countries benefit from stronger reimbursement systems, centralized planning, and higher surgical volume, whereas LMICs face limited public budgets, weak reimbursement, high out-of-pocket expenditure, maintenance barriers, and low procedural volume. Conclusion: Robotic surgery programs in LMICs require cautious, planned, and context-specific implementation. Sustainable models should rely on high-volume referral hubs, multi-specialty utilization, negotiated procurement, adapted reimbursement and periodic cost-effectiveness evaluation.