Safety, feasibility, and early outcomes of one hundred robotic bariatric procedures at a high-volume center.

To evaluate the outcomes of robotic bariatric surgery in our center, including sleeve gastrectomy (SG) and one-anastomosis gastric bypass (OAGB), focusing on operative time, perioperative complications, and length of hospital stay. A retrospective review identified 100 consecutive patients who underwent robotic bariatric surgery between February 2024 and September 2025. Of these, 78 underwent SG and 22 underwent OAGB. Baseline data included age, sex, body mass index (BMI), and obesity-related comorbidities. Operative time, docking time, perioperative complications, and length of hospital stay were analyzed. The mean patient age was 37 ± 8 years, with a mean BMI of 44.7 ± 5.4 kg/m². Comorbidities included diabetes mellitus in 11 patients, obstructive sleep apnea syndrome in 6, and hypertension in 35. All 100 procedures (78 Robotic Sleeve Gastrectomy, R-SG, and 22 Robotic one-anastomosis gastric bypass, R-OAGB) were completed successfully without conversion. The median total operative time was 87 min for R-SG and 96 min for R-OAGB. A significant reduction in the mean operative time for the entire cohort was observed, dropping from 166.36 min during the initial phase (Feb-Aug 2024) to a steady state of 91 min in the final period (Apr-Sep 2025). Mean docking time also improved, stabilizing at 7.4 min. Overall 30-day morbidity was 8%: 4 cases of intraluminal hemorrhage (endoscopically managed), 1 late gastric fistula (1% leak rate, managed conservatively), and 3 medical ICU admissions. No conversions or mortality occurred. Mean total costs dropped by 46.5% (€12,862.28 to €6877.50). Mean hospital stay was 3.2 ± 0.3 days. Our experience demonstrates that robotic SG and OAGB are safe and feasible, with acceptable operative times, a low complication rate, and short hospital stays. Robotic surgery facilitates complex maneuvers, particularly in patients with comorbidities or high BMI. The initial "cost penalty" is a temporary phase; with increasing volume and team proficiency, the Da Vinci Xi system becomes economically sustainable.