<p>Obesity affects over one billion people worldwide, with bariatric and metabolic surgery remaining the most durable treatment for severe disease. Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is an increasingly utilised procedure in primary, revisional, and super-obese patients due to its metabolic efficacy and streamlined surgical design. Robotic assistance has been adopted to facilitate technically demanding components of SADI-S; however, the available evidence is limited to small observational studies with few laparoscopic comparators. This systematic review and limited meta-analysis aimed to synthesise current evidence on perioperative and postoperative outcomes following robotic SADI-S. This systematic review was conducted in accordance with PRISMA and the Cochrane Handbook guidlines. Five electronic databases (PubMed, Embase, Scopus, Web of Science, CENTRAL) were searched to October 2025 to identify studies reporting perioperative or weight-related outcomes following robotic SADI-S in adults. Data on patient characteristics, operative details, and postoperative outcomes were extracted. Risk of bias was assessed using the NIH Quality Assessment Tools. Where comparative data were available, outcomes were pooled using random-effects meta-analysis; single-arm robotic cohorts were synthesised descriptively. Eight observational studies including 237 patients undergoing robotic SADI-S were identified (166 primary, 71 revisional). No conversions to laparoscopy or open surgery were reported. One intraoperative complication (minor bleeding) occurred. Operative time ranged from 128 to 206&#xa0;min, and median length of stay ranged from same-day discharge to 3 days in most series. Across all studies, no postoperative mortality and no complications beyond 30 days were reported. Two propensity score–matched comparative studies (96 patients) were included in meta-analysis. Robotic SADI-S was associated with a significantly longer operative time compared with laparoscopic SADI-S (mean difference 64.95&#xa0;min, 95% CI 48.59–81.31; I² = 0%). There were no statistically significant differences between robotic and laparoscopic SADI-S in postoperative complications, ICU admission, 30-day readmission, or reoperation. Weight-loss outcomes were reported inconsistently and could not be pooled. Robotic SADI-S is a technically feasible approach with low reported perioperative morbidity in the available literature. However, current evidence is limited by small observational cohorts, short and heterogeneous follow-up, and sparse comparative data, with consistently longer operative times and insufficiently reported weight-loss outcomes. Larger, prospective studies with standardized outcome reporting are required to define the clinical value of robotic assistance in SADI-S.</p>