OBJECTIVES: To compare clinical and economic outcomes for conventional laparoscopic (LAP) and robotic assisted minimally invasive surgery for segmental colectomies.   METHODS: Using the Premier hospital database patients >=18 years of age having one of the following primary LAP colectomies performed in 2009 to Q2 2011 were identified:  cecectomy, hemi colectomy, left hemi colectomy, and sigmoidectomy. Those procedures utilizing robotic technology were identified if one of two conditions were met: 1) A robotic ICD-9 procedure code accompanied the primary procedure of interest, or 2) “text” fields in the hospital charge master file indicated use of the robot. Patients were matched on laparoscopic versus robotic colectomy using a propensity score on severity, certain demographic and hospital characteristics, and 1:1 on type of procedure. The association between robot-assisted colectomy and adverse events, hospital costs, surgery time, and length of stay was examined.   RESULTS: Of 25,758 patient records from 364 hospitals, 98% (n=25,210) of laparoscopic colectomies were performed without robotic assistance; 2% (548) with robotic assistance.  After matching, 1,066 patients remained, 533 in each group. No significant differences existed between the matched cohorts for major, minor and/or surgical complications.  Use of the robot was associated with statistically higher mean per patient hospital costs.  Inpatient procedures with and without robot assistance cost $17,445 vs. $15,447 (p=0.0008) respectively.  The analysis did not include capital costs or service fees associated with maintaining the robot.  Inpatient surgery times were significantly longer for robot-assisted procedures than non-robot procedures (4.37 vs. 3.34 hours; p <0.0001). Length of stay was similar. CONCLUSIONS: Findings reveal minimal clinical differences in peri and post-operative events and length of stay. There were significant increases in cost per case and OR time for robotic assisted versus conventional LAP procedures.  These results call into question the cost-effectiveness of this technology in these procedures.