Background <p>Evaluation of the utilization and outcomes of robotic-assisted bariatric surgery (RA-BS) is needed. This study investigates the current utilization trends and outcomes of robotic-assisted (RA) versus laparoscopic primary bariatric surgery.</p> Methods <p>RA and laparoscopic primary Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) were compared using the 2018–2021 MBSAQIP participant user data files. A total of 678,357 patients were propensity matched 1:1 based on 12 variables. A total of 198,630 patients were included in the study group: 145,858 matched to SG and 52,772 to RYGB.</p> Results <p>From 2018 to 2021, there was an increase in the percentage of RA-BS procedures from 10 to 25%. L-SG had significantly lower rates of superficial infection (0.22% vs. 0.29%), organ space infection (0.18% vs. 0.24%), post-operative transfusion (0.46% vs. 0.68%), gastrointestinal bleed (0.19% vs. 0.26), and reoperation (0.63% vs. 0.74%) compared to RA-SG. RA-RYGB had significantly lower rates of superficial infection (0.37% vs. 0.8%), post-operative transfusion (0.75% vs. 1.1%), and gastrointestinal bleed (0.6% vs. 0.9%) compared to L-RYGB. There were statistically significant decreases in operative time, and 30-day outcomes of reoperation, intervention, and readmission for both laparoscopic and RA-BS over time from 2018 to 2021.</p> Conclusion <p>There was a progressive increase in the number and percentage of RA procedures. Most perioperative outcomes were statistically equivalent. RA-RYGB was associated with lower complication rates of infection and bleeding, while RA-SG was associated with higher rates of infection, bleeding, and reoperation. Continued research is needed to understand the efficacy and clinical significance of RA-BS.</p>