HYPOTHESIS The cost of robotic thyroidectomy (RT) is significantly higher than that of standard open thyroidectomy (ST). DESIGN A retrospective cost analysis of ST was compared with a projected cost analysis of RT using institution-specific data. SETTING Endocrine surgery division at an academic center. PARTICIPANTS Standard open thyroidectomy data from 2 high-volume endocrine surgeons vs published variables from high-volume RT surgeons. MAIN OUTCOME MEASURES A cost analysis was performed for ST (Current Procedural Technology code 60240). The cost of RT was estimated as operative time plus anesthesia fees plus consumables plus the robotic system (da Vinci Surgical System; Intuitive Surgical, Inc). Institution-specific data were collected for ST, and only those costs that varied between ST and RT were included in the analysis. The mean operative time for ST was based on data from 2 high-volume endocrine surgeons at our institution. The RT operative data were extracted from published series of high-volume RT surgeons. RESULTS The relative costs calculated were $2668 for ST vs $5795 for RT. This represents a 217% increased cost of RT compared with ST. The mean operative times were 113 minutes for ST vs 137 minutes for RT. CONCLUSIONS Technologic advances are paramount in providing the best medical care for patients. This progress must be tempered by a rational, open discussion about the costs of these advancements. Only then can the proposed benefits of a new technology be weighed accurately against the overall societal cost. Surgeons need to be aware of the cost of their technologic choices and the burdens that those place on limited resources.