A randomized trial reveals no significant cost benefit of robotic pancreatoduodenectomy compared to open surgery, despite higher intraoperative costs.

• Total hospital costs were similar: €30,956 for robotic vs. €28,271 for open (p=0.538).
• Robotic technique had significantly higher intraoperative costs (€11,906 vs. €6,451, p<0.001) but lower postoperative costs (€19,051 vs. €21,856).
• Health-related quality of life scores were slightly worse at 6 months for robotic patients, leading to a less than 30% probability of it being cost-effective.

Surgeons should weigh the potential benefits of robotic surgery against its costs, particularly since outcomes show a slight decline in quality of life after 6 months.