Introduction of robotics in a pediatric bariatric program - advantages and opportunities

Robotic-assisted bariatric surgery remains uncommon in pediatric surgery. This approach has been suggested to decrease narcotic use and hospital stay, but requires training, investment, a learning curve, and has been associated with increased costs and operative time. This study evaluates outcomes for adolescent patients undergoing robotic and laparoscopic sleeve gastrectomy. A retrospective review of patients that underwent sleeve gastrectomy was performed at a freestanding academic children's hospital between 2021 and 2025. Demographics, perioperative and follow-up data were collected using the American Society for Metabolic and Bariatric Surgery's recommended reporting standards. Operative and surgical outcomes were compared between robotic-assisted and laparoscopic approaches for sleeve gastrectomy. Forty-five patients in the robotic cohort were compared to 84 patients that underwent a laparoscopic approach. The average age at surgery (p = 0.13), sex (p = 0.43), race (p = 0.63), ethnicity (p = 0.47), and average BMI (p = 0.37) were similar between groups. The average length of hospitalization was shorter in the robotic group compared to the laparoscopic cohort (1.5 vs. 2.1 days, p = 0.04). Both average operative time (90.1 vs. 67.3 min, p < 0.01) and supply cost ($4,711 vs. $3,028, p < 0.01) was higher within the robotic group. No significant differences between groups were observed between postoperative complications and narcotic (p = 0.84) or antiemetic use (p = 0.48). Adolescent patients undergoing robotic sleeve gastrectomy may benefit from overall shorter hospital stays, but with an increased supply cost and longer operative times. As experience is accrued, operative time may continue to decrease and robotic sleeve appears to be a safe approach for adolescent patients.