Real Robotic 3-arm, 3-port versus laparoscopic Roux-en-Y gastric bypass: a prospective single-center comparative study of operative time, costs and short-term outcomes.

Robot-assisted Roux-en-Y gastric bypass (RYGB) may facilitate suturing and ergonomics, but its value versus laparoscopy remains debated. We compared laparoscopic RYGB with a standardized Real Robotic 3-arm, 3-port technique. This prospective, single-center, non-randomized study included consecutive primary RYGB procedures performed from December 2024 to December 2025. The primary per-protocol analysis excluded non-isolated procedures, one conversion, and one robotic protocol deviation; an as-intended sensitivity analysis retained both intended robotic cases. Outcomes included operating-room times, direct material costs, length of stay, 30-day complications and readmissions, and surgeon satisfaction. The primary analysis included 109 patients (61 LGB, 48 RGB). Groups were broadly comparable, although hypertension was more frequent in RGB. Preparation time was slightly longer with RGB (median 34 vs. 29 min; shift 5.0 min, 95% CI approximately 0.0-9.0; p = 0.049), as were skin-to-skin time (144.5 vs. 113.0 min; shift 32.0 min, 95% CI 20.0-44.0; p < 0.001) and total operating-room occupancy (180 vs. 140 min; shift 38.0 min, 95% CI 22.0-50.0; p < 0.001). Direct material costs were modestly higher with RGB (median €2,044.3 vs. €1,931.3; shift €113.06; p < 0.001). Length of stay was one day in both groups. No leaks occurred, and no statistically significant differences were detected in 30-day complications or readmissions. Surgeon satisfaction was numerically higher with RGB but not statistically significant (p = 0.050). After the initial learning curve, the standardized robotic technique appeared feasible within an experienced single-center team. It was associated with longer operative times and modestly higher direct material costs, without statistically significant differences in short-term clinical outcomes.