Early Outcomes, Learning Curve and Cost Analysis of Totally Robotic Sleeve Gastrectomy

Robotic sleeve gastrectomy (RSG) is gaining adoption in metabolic bariatric surgery, yet evidence on its perioperative safety, efficiency, and costs during the early learning phase remains limited. To evaluate outcomes, learning curve dynamics, and procedural costs for totally robotic sleeve gastrectomy. Academic center. A retrospective analysis was conducted of the first 53 consecutive RSGs (April 2023–July 2025) performed by a single surgeon using a standardized fully robotic technique. Perioperative variables, 30-day morbidity, and cost data were collected. Learning curves for docking time, console time, and total operative time were assessed using Cumulative Sum (CUSUM) analysis. Mean age and BMI were 38.1 ± 12.6 years and 41.6 ± 6.3 kg/m 2 , respectively; 71.7% were female. Overall complication rate was 7.5% (3 bleedings, 1 leak) with no mortality or reinterventions. ICU admission and readmission each occurred in 1.9% of cases. Mean docking time was 17.8 ± 9.4 min, console time 51.5 ± 17.0 min, and total operative time 69.3 ± 18.1 min. The mean length of stay was 3.6 ± 1.1 days (range 2–10). CUSUM identified proficiency points at case 18 for docking time (− 51.1%), case 23 for console time (− 18.6%), and case 22 for total operative time (− 21.5%). Median length of stay was 3 days. Mean direct instrument/stapling cost per RSG was €4,535. Totally RSG can be introduced with safe outcomes even during the learning phase. Proficiency for operative efficiency was reached after 20 cases.