Background <p>Minimally invasive ileal pouch-anal anastomosis (IPAA), including laparoscopic and robotic-assisted approaches, has been shown to improve outcomes for ulcerative colitis (UC), but few studies have compared outcomes between robotic-assisted and conventional laparoscopic IPAA. This study aimed to evaluate short-term outcomes of robotic-assisted versus laparoscopic IPAA.</p> Methods <p>This retrospective cohort study utilized the U.S. Nationwide Readmission Database from 2016 to 2020. Patients aged ≥ 18&#xa0;years undergoing robotic or laparoscopic IPAA for UC were included. Outcomes measured were in-hospital mortality, length of stay (LOS), hospital costs, complications, and 30-day and 90-day readmission rates. Propensity score matching (PSM) was employed to balance baseline characteristics, and multivariable regression was applied for adjusted analyses.</p> Results <p>Among 820 patients with UC undergoing IPAA, 242 robot-assisted and 242 laparoscopic cases were matched after PSM. Baseline demographic and clinical characteristics were well balanced following PSM. Robotic-assisted IPAA was associated with higher total hospital costs compared with the laparoscopic approach (adjusted mean difference, 24,460 USD; 95% CI 7.69–41.24; <i>p</i> = 0.004). No significant differences were observed between groups in LOS, overall postoperative complications, or 30- and 90-day readmission rates.</p> Conclusion <p>In this nationwide analysis, robotic-assisted IPAA was associated with higher hospital costs but comparable short-term clinical outcomes relative to laparoscopy. These findings suggest that while robotic IPAA is feasible and safe, its higher cost without clear short-term clinical benefit warrants careful consideration when selecting the surgical approach.</p>