Robotic 3-arm Roux-en-Y gastric bypass: a feasible, safe and cost-effective approach based on patient selection

Robotic-assisted Roux-en-Y gastric bypass (RYGB) is a well-established procedure in bariatric surgery, offering enhanced precision, ergonomics, and visualization. While the conventional four-arm robotic approach is widely used, it may increase operative costs and complexity. This report presents a case of a 33-year-old female with a BMI of 50.7 who underwent a robotic three-arm RYGB, aiming to evaluate the feasibility, safety, and efficiency of this streamlined technique. A modified three-port configuration was used, along with suture-based liver retraction. Key steps included gastric pouch creation, gastrojejunal and jejunojejunal anastomoses using stapled and hand-sewn techniques, and Roux limb configuration confirmed by methylene blue leak testing. The procedure was completed without intraoperative complications, with a console time of 120 min. The patient resumed oral fluids within 1 h, ambulated at 2 h, and was discharged within 24 h. No postoperative complications were observed. Compared to the standard four-arm approach, the three-arm technique maintained surgical efficacy while potentially reducing costs, postoperative pain, and improving reproducibility. This case highlights the potential utility of a three-arm robotic RYGB approach in select patients. Larger studies are needed to validate these findings and assess long-term outcomes, training adaptability, and scalability across surgical centers.