Background <p>The use of robotic surgery has expanded rapidly; however, its cost-effectiveness in foregut surgery remains unclear. We aimed to compare early postoperative outcomes and procedure-related costs between robotic (R-) and laparoscopic (L-) antireflux surgery (ARS).</p> Methods <p>This retrospective cohort and cost-effectiveness study was conducted using a prospectively maintained database of adults who underwent minimally invasive ARS by a single experienced esophageal surgeon. All primary elective R-ARS cases (September 2016–December 2024) were identified, and perioperative outcomes and procedure costs (US$) were compared to a 1:1 propensity-score matched L-ARS cohort. Moreover, incremental cost-effectiveness ratios (ICERs) were calculated for predefined outcomes.</p> Results <p>In total, 138 patients (69 R-ARS, 69 L-ARS) were included. R-ARS was associated with a longer median operating room utilization time (169 vs 128&#xa0;min., <i>p</i> &lt; 0.001) and length-of-stay (2 vs. 1&#xa0;days, <i>p</i> = 0.045) and slightly more intraoperative complications (5.8 vs. 1.4%, <i>p</i> = 0.362). Early complications (10.1% both), ICU admissions (R-ARS, 2.9% vs. L-ARS, 1.4%, <i>p</i> &gt; 0.999), and 90-day readmissions (R-ARS, 6.1% vs. L-ARS, 3.3%, <i>p</i> = 0.749) were similar between the groups. The median all-inclusive cost was higher with R-ARS ($15,676.1 vs. $7694.9, <i>p</i> &lt; 0.001). Although the incidence of patient-reported postoperative dysphagia was similar after R-ARS or L-ARS (26.1 vs. 30.4%, <i>p</i> = 0.705), resulting endoscopic interventions were more frequent after R-ARS (16/18 [88.9%] vs. 9/21 [42.9%], <i>p</i> = 0.008). The ICERs for intraoperative complications and 90-day readmissions were –$181,390.9 (favoring L-ARS) and $285,042.9 (favoring R-ARS), respectively.</p> Conclusion <p>Overall, R-ARS may not offer superior short-term safety compared to L-ARS, utilizes greater resources, and appears to be less cost-effective.</p>