Robotic-Assisted Cardiothoracic Surgery: Advancements, Challenges, and Global Disparities in Care

Robotic surgical technology has revolutionized cardiothoracic surgery. As a relatively new technology, not much research has been done; initial screening from PubMed and Google Scholar using the keywords “robotic cardiothoracic surgery” showed 70 relevant articles spanning 24 years. Robotic-assisted mitral valve surgery shows evidence for significantly lower 30-day mortality (0.6% vs. 2.4%,<0.001), reduced hospital stays, and fewer blood transfusions compared to sternotomy approaches. Robotic coronary procedures, including RA-MIDCAB and TECAB, demonstrate comparable graft patency and mortality rates to traditional CABG, with superior postoperative recovery profiles. Robotic cardiac surgery in morbidly obese patients yielded better outcomes than conventional approaches. Integration of AI in preoperative planning has outperformed traditional scoring systems in risk stratification. However, adoption remains constrained by high set-up costs and technical complexity, with widespread uptake occurring primarily in high-volume, well-funded centers with robust training infrastructures. A review of the literature shows global disparities—both technical and economic—leaving lesser-funded regions with higher risk and associated mortalities. There is a need for broader AI integration, reduced hardware costs, and standardized international training. Strategic institutional commitment, team-based learning models, and registry-based outcome tracking are critical to overcoming current barriers and realizing the full potential of robotic surgical technologies.