National trends and outcomes of robotic and laparoscopic bariatric surgery in the United States
In brief
Laparoscopic bariatric surgery had 42% lower odds of major complications
In a national study of about 1.14 million operations, laparoscopic surgery was associated with 42% lower adjusted odds of major adverse events than robotic surgery. It was also linked to fewer infections and readmissions and lower costs, but the observational comparison cannot show that the surgical approach caused these differences; prospective studies are needed to weigh robotic surgery's clinical and economic value.
- Journal
- Surgery (Q1)
- Published
- 31 August 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Darren Tran, Konmal Ali, Jayden Wong, Stephanie Bossolina, Owen Lai, Yijun Chen, et al.
- PMID
- 42805017
- DOI
- 10.1016/j.surg.2026.110574
Why clinicians should know about it
- Picked for Bariatric and Metabolic Surgery (paper of the day, 29 September 2026): National trends and outcomes of robotic vs laparoscopic bariatric surgery
Abstract
BACKGROUND: While robotic-assisted metabolic and bariatric surgery has experienced rapid national adoption, data on postoperative outcomes relative to laparoscopic approaches remain mixed. The present study used a nationally representative cohort to characterize outcomes and resource utilization across laparoscopic and robotic metabolic and bariatric surgery. METHODS: All elective adult (≥18 years) hospitalizations for primary robotic or laparoscopic metabolic and bariatric surgery were extracted from the 2016-2022 National Readmissions Database. Eligible procedures included adjustable gastric banding, biliopancreatic diversion/duodenal switch, Roux-en-Y gastric bypass, and sleeve gastrectomy. Multivariable models were developed to assess the association of procedure approach with outcomes of interest. Restricted cubic spline analysis examined the volume-cost relationship at the hospital level. RESULTS: Of an estimated 1,136,027 patients, 938,999 (82.6%) comprised the laparoscopic cohort. Compared with robotic metabolic and bariatric surgery, the laparoscopic cohort was less commonly female and demonstrated lower Elixhauser Comorbidity Indices. Following risk adjustment, laparoscopic intervention was associated with reduced odds of major adverse events (adjusted odds ratio, 0.58; 95% confidence interval, 0.46-0.75), infectious complications (adjusted odds ratio, 0.28; 95% confidence interval, 0.18-0.42), and respiratory complications (adjusted odds ratio, 0.81; 95% confidence interval, 0.71-0.92). The laparoscopic approach was additionally associated with lower costs (β = -4.1; 95% confidence interval, -4.6 to -3.7) and reduced odds of 30-day readmission (adjusted odds ratio, 0.85; 95% confidence interval, 0.81-0.90), compared with robotic. CONCLUSION: In this nationally representative analysis, robotic metabolic and bariatric surgery was not associated with a short-term clinical advantage over laparoscopic approaches, despite higher resource utilization. These findings underscore the need for rigorous prospective evaluation of the clinical and economic value of robotic metabolic and bariatric surgery prior to its continued expansion.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.