The aim of our study was to evaluate our experience with robotic-assisted antireflux surgery in comparison to the traditional laparoscopic approach. Methods: We performed a retrospective analysis of a prospective database of patients who underwent surgery for primary gastroesophageal reflux disease between January 2004 and April 2008. Patients with recurrent disease, paraesophageal hernia, or operations other than Nissen fundoplication were excluded. Patients were surveyed in the fall of 2008 regarding symptoms (heartburn, regurgitation, nausea/vomiting, dysphagia, chest pain, bloating, and diarrhea) and subjective perception of the success or failure of the operation. Results: A total of 211 patients were identified (144 laparoscopic, 67 robotic), of whom 100 consented to participate in the study (60 laparoscopic, 40 robotic). There were no significant differences in demographics between groups (laparoscopic vs. robotic: 40% vs. 42% male, p=0.8; age 57.7 ± 13.6 vs. 52.6 ± 14.5, p=0.75; BMI 29.1 ± 5.1 vs. 28.7 ± 4.1, p=0.7). Operative time was increased in the robotic group (table), although length of stay was not different (p=0.1). Complications in the laparoscopic group were urinary retention (n=2) and bleeding from the splenic pole that was identified and managed intra-operatively (n=1). No patients in the laparoscopic group required re-operation. In the robotic group one patient developed a port site hernia requiring re-operation. There was one conversion from robotic to laparoscopic procedure due to failure to progress. One patient in the robotic group presented at 12 months with recurrent symptoms and was found to have an incomplete fundoplication at repeat operation. Overall 80% of patients thought that the operation was subjectively successful, with no difference between groups (laparoscopic 80% vs. robotic 77%, p=0.83). Heartburn was subjectively improved in 85% of patients and regurgitation was improved in 90% of patients, with no difference between groups (p=0.23 and 0.77, respectively). There were no significant differences between groups for the other symptoms surveyed.Conclusion: Laparoscopic and Robotic-assisted antireflux operations both seem to provide the same level of subjective symptomatic improvement after approximately 3 years. Robotic antireflux surgery took longer to perform than traditional laparoscopic surgery, which may negatively impact cost-effectiveness of surgery.