**Abstract**

Hysterectomy is one of the most common operations performed in gynecology. In the last decade and a half, the da Vinci robotic system has gained widespread acceptance in gynecology due to enhanced visualization and excellent dexterity compared to conventional laparoscopic techniques. The rapid adoption of the technology comes with unique challenges. Excluding initial acquisition cost and maintenance cost, surgery performed robotically is expensive than laparoscopic surgery. Higher cost on each case questions many about the viability of the robotic platform. Several hospitals have successfully established the robotic program, but many are reluctant to acquire expensive technology, and some are rolling back on their decision due to various reasons. This chapter expands on those challenges, mainly needs assessment, team building, culture of safety, learning curve, business strategy, and return of investment.

**Keywords:** Robotic hysterectomy, need assessment, team building, learning curve, culture of safety, business model
