A study compared robot-assisted (R) and laparoscopic (L) approaches for bariatric procedures in super-obese (SO, BMI ≥ 50 kg/m²) and super-super-obese (SSO, BMI ≥ 60 kg/m²) patients. The study evaluated clinical outcomes and cost-effectiveness of R versus L for Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) and Roux-en-Y Gastric Bypass (RYGB). Data from 4596 patients (2012–2023) were analyzed, with 174 RYGB and 91 SADI-S cases selected. After propensity score matching, 88 patients were analyzed (44 in each group). R procedures had longer operative times (199.1 vs. 109.5 min) but higher costs. However, when only SSO patients were considered, the difference in operative time was eliminated. R procedures were associated with higher costs, but may offer advantages in complex cases like SSO patients. Both approaches had comparable complication rates and post-operative stays. The study concluded that while robotic surgery is more expensive, it may provide added value for complex cases, especially in an economically sustainable model. The study also highlighted the need for larger, longer-term studies to confirm findings.A study compared robot-assisted (R) and laparoscopic (L) approaches for bariatric procedures in super-obese (SO, BMI ≥ 50 kg/m²) and super-super-obese (SSO, BMI ≥ 60 kg/m²) patients. The study evaluated clinical outcomes and cost-effectiveness of R versus L for Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) and Roux-en-Y Gastric Bypass (RYGB). Data from 4596 patients (2012–2023) were analyzed, with 174 RYGB and 91 SADI-S cases selected. After propensity score matching, 88 patients were analyzed (44 in each group). R procedures had longer operative times (199.1 vs. 109.5 min) but higher costs. However, when only SSO patients were considered, the difference in operative time was eliminated. R procedures were associated with higher costs, but may offer advantages in complex cases like SSO patients. Both approaches had comparable complication rates and post-operative stays. The study concluded that while robotic surgery is more expensive, it may provide added value for complex cases, especially in an economically sustainable model. The study also highlighted the need for larger, longer-term studies to confirm findings.