Robotic versus laparoscopic primary metabolic and bariatric surgery: a propensity score–matched analysis of the German StuDoQ/MBE registry

Abstract Background: Real-world data on perioperative outcomes after robotic-assisted metabolic bariatric surgery (MBS) remain vastly heterogeneous. In this study, short-term perioperative outcomes of robotic-assisted and laparoscopic primary MBS were compared at the national level in Germany. Methods: Data from the national prospective German clinical quality registry (StuDoQ/MBE) were analyzed. Patients undergoing robotic-assisted or laparoscopic primary MBS between 2014 and 2025 were compared after 1:1 propensity score matching. Matching variables were age, sex, body mass index, ASA classification, Charlson Comorbidity Index, year of surgery, and procedure type. The primary endpoint was the occurrence of postoperative complications. Secondary endpoints include occurrence of major complications, mortality, operative time, and postoperative length of stay. Temporal trends were explored using mixed regression models. Results: 138,696 laparoscopic and 3,930 robotic-assisted cases were included. After 1:1 propensity score matching, robotic-assisted and laparoscopic procedures were compared. Robotic-assisted surgery was associated with higher odds of overall postoperative complications (odds ratio [OR] 1.34, 95% CI (1.10;1.64); p = 0.0038). There were no statistically significant differences in the occurrence of major complications, while mortality was similarly rare in both cohorts. Operative times of robotic-assisted procedures were longer, with a mean difference of 27.14 minutes (95% CI (25.24;29.04); p < 0.0001). Postoperative length of stay was comparable between groups. Conclusions: Thus far, robotic-assisted primary MBS is not widely adopted in Germany. A higher risk of overall complications and a longer surgical duration, along with a steep reduction over time compared to the laparoscopic approach, denote ongoing learning curves. Of note, the occurrence of major complications, mortality risk, and postoperative length of stay were comparable during the early implementation phase.