Minimally invasive surgery has impacted the outcomes of surgery more than any technology since the development of sterile technique. The hard science has demonstrated that decrease in wound complications and recovery time has created the biggest gap with open approaches to surgery. The total economic benefit may be unfathomable when looked at comprehensively. Integral to the rise of minimal access and therapeutic techniques in surgery has been the growth of technological improvements over time. Beginning with insufflators, videoscopy, and energy devices, that evolution has continued into the development of tele-surgical devices that feature full articulation of instruments, high-resolution 3-D optics, and computer assisted movement. This has come with controversy – as the dominant manufacturer of robotic assisted devices, Intuitive Surgical, and their generations of da Vinci surgical platforms, holds enough market share to spur cries of monopoly and financial excess.  However, with over 3000 world-wide systems in use, and over 6000 peer-reviewed research articles, the impact of robotic surgery cannot be ignored.  The current state of data suggests equivalency in most procedures with regard to traditional outcome measures, equal or somewhat elevated costs, with specific areas of superiority.