Prospective comparison of robotic versus laparoscopic one-anastomosis gastric bypass: real-life analysis of procedural standardization and safety during the initial adoption phase.

The adoption of robotic One-Anastomosis Gastric Bypass (rOAGB) is increasing, yet comparative data with the established laparoscopic approach remain limited. This study evaluates the initial adoption phase of rOAGB by a single surgeon, focusing on procedural consistency and safety compared to a laparoscopic (LAP) team. We prospectively analyzed 135 consecutive patients undergoing primary OAGB between October 2024 and October 2025. 81 LAP procedures (LAP group) were compared to 54 robotic procedures (rOAGB group). The rOAGB cohort represented the first series of this specific procedure for a surgeon experienced in other robotic platforms. The primary endpoint was procedural standardization, measured by operative time (OT) variance. Secondary endpoints included 30-day morbidity. The rOAGB series was chronologically divided into two six-month periods based on the study's one-year duration. This temporal split resulted in an equal distribution of cases (27 procedures per semester). Baseline characteristics were comparable (p > 0.05). LAP was significantly faster (mean OT 86.0 ± 26.6 min vs. 96.8 ± 20.8 min; p = 0.004). However, rOAGB demonstrated a significantly narrower distribution of OTs (SD 20.8 vs. 26.6). In the rOAGB cohort, an F-test revealed a significant reduction in OT variance between the first and second semester of activity (p = 0.0134), indicating rapid stabilization. 30-day complication rates were similar (1.2% LAP vs. 3.7% rOAGB; p = 0.56). While LAP surgery remains faster, the robotic platform facilitates superior procedural consistency during the adoption phase. The robotic approach achieved significant standardization within 27 cases, maintaining a safety profile comparable to the established LAP technique.