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A retrospective cohort study was conducted using Premier Healthcare Database, from 2020 to 2023. The study included adult patients with Body Mass Index 30 or higher who underwent elective inpatient RYGB surgery via RAS or LAP. RAS and LAP cohorts were matched through propensity scoring. Regression models with standard errors clustered by matched pair were used to estimate associations between surgical approach and perioperative outcomes. After matching, RAS-RYGB was associated with lower odds of conversion to open surgery (OR, 0.48; 95% CI, 0.32-0.73), ICU admission (OR, 0.57; 95% CI, 0.45-0.73), blood transfusion (OR, 0.77; 95% CI, 0.63-0.95) compared with LAP-RYGB. RAS-RYGB was also associated with slightly lower odds of being in a higher length-of-stay category (OR, 0.85; 95% CI, 0.81-0.89) and have 30-day all-cause reencounters (OR, 0.87; 95% CI, 0.82-0.91). Operating room time was longer with RAS-RYGB (mean difference, 17.5\u00a0min; 95% CI, 16.1-18.9), and bowel obstruction was more frequent (OR, 1.25; 95% CI, 1.01-1.54). Other perioperative complications were similar between groups. RAS-RYGB was associated with lower conversion to open surgery, blood transfusion, ICU admissions, modest shift towards shorter length of stay and post-operative visits than LAP-RYGB, but with higher bowel obstruction and longer operating time.<\/jats:p>","DOI":"10.1007\/s11701-026-03734-6","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T03:08:35Z","timestamp":1785380915000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative analysis of robotic assisted versus laparoscopic Roux-en-Y gastric bypass: a retrospective cohort study"],"prefix":"10.1007","volume":"20","author":[{"given":"Matthew L.","family":"Brengman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8442-2216","authenticated-orcid":false,"given":"Prajakta H.","family":"Waghmare","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I-Fan","family":"Shih","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"3734_CR1","unstructured":"WHO Obesity [cited 2023 May 19]. 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