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

Background: 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. Objectives: To evaluate outcomes, learning curve dynamics, and procedural costs for totally robotic sleeve gastrectomy. Setting: Academic center. Methods: 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. Results: Mean age and BMI were 38.1 ± 12.6 years and 41.6 ± 6.3 kg/m2, 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. Conclusions: Totally RSG can be introduced with safe outcomes even during the learning phase. Proficiency for operative efficiency was reached after 20 cases.