Robotic versus laparoscopic sleeve gastrectomy in adolescents: trends and short-term complications.

BACKGROUND: Robotic sleeve gastrectomy (SG) is increasingly used, but national comparative data in adolescents and young adults remain limited. OBJECTIVES: To evaluate robotic SG trends and compare 30-day outcomes after robotic versus laparoscopic SG among patients aged 13 to 21 years. SETTING: Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, United States, 2015-2024. METHODS: We performed a retrospective cohort study of patients aged 13 to 21 years undergoing minimally invasive SG. Outcomes included grouped complications, 30-day readmission, overall complications, and operative time. Multivariable regression adjusted for age, sex, body mass index, comorbidities, smoking, and year; propensity score matching and inverse probability weighting were sensitivity analyses. RESULTS: Among 21,746 patients, 17,444 underwent laparoscopic SG and 4302 underwent robotic SG. Robotic utilization increased from 6.8% in 2015 to 34.3% in 2024. Robotic SG was not associated with higher adjusted odds of infectious complications (odds ratio, 1.04; 95% confidence interval, .65-1.62), pulmonary complications (1.34; .50-3.22), thromboembolic complications (1.85; .73-4.34), surgical complications (1.43; .91-2.18), readmission (1.01; .80-1.27), or overall complications (1.05; .85-1.29). Low event rates limited power for rare outcomes. Sensitivity analyses were concordant. Robotic SG had longer operative time by 21.2 min. CONCLUSIONS: Robotic SG use increased nationally and was not associated with higher adjusted odds of complications, supporting short-term safety. Future studies should evaluate longer-term outcomes, cost, and access.