Studies reporting on the recurrence rate after laparoscopic repair of large hiatal hernias (HH), including anatomical asymptomatic recurrence, are scarce. This prospective cohort study evaluated the symptomatic and objective outcome of robot-assisted laparoscopic HH repair up to more than 1 year after surgery. A prospective cohort study was performed on 40 consecutive patients with emphasis on operating times, blood loss, intra- and postoperative complications, symptomatic outcome, and anatomical recurrence rate at a minimum of 1 year after surgery. Robot-assisted laparoscopic HH repair proved to be an effective technique with a relatively low mid-term recurrence rate in this prospective series. The operating team experienced the support of the robotic system as beneficial, especially in the dissection of the hernia sac and extensive crural repair.