ORIGINAL RESEARCH article
Front. Surg.
Sec. Thoracic Surgery
This article is part of the Research TopicAdvances in the Management of Postoperative Air Leak Following Pulmonary ResectionView all articles
Is it Safe to Remove the Chest Tube in the Operating Room after Robotic Lobectomy, Segmentectomy and Wedge Resection with Lymphadenectomy?
Provisionally accepted
- 1Langone Medical Center, New York University, New York City, United States
- 2NYU Langone Health, New York, United States
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ABSTRACT Background: We have previously shown it is safe to remove chest tubes within four hours after robotic pulmonary resection with aggressive thoracic lymphadenectomy in patients without an air leak. Methods: This is a prospective quality improvement study that examines removing chest tubes before the patient leaves the OR after robotic pulmonary resection. Chest tubes were removed in the OR if the air leak was ≤75 ml/minute on a digital drainage system. Chest tubes were re-inserted only for oxygen desaturations from increasing pneumothorax and/or increasing subcutaneous emphysema. Results: From March 1, 2023 until December 12, 2024, 223 consecutive patients underwent pulmonary resection with complete lymphadenectomy by one surgeon. Overall, 130 patients (58%) had their chest tubes removed in the OR, in 54% (62/114) of lobectomies, 62% (48/78) of segmentectomies and 65% (20/31) of wedge resections. Thirteen patients (10%) required chest tube re-insertion, 11 after lobectomy and 2 after segmentectomy. Median operative time was 90 minutes (range 29-244), blood loss was 20 ml (range 10-60), all patients went home on postoperative day 1 except one. There was no 30-day or 90-day mortality. Postoperative thoracentesis was performed in 1%. Conclusion: Chest tubes can be safely removed in selective patients before leaving the OR after robotic pulmonary resection with complete lymphadenectomy. Factors that may lead to these outcomes are meticulous intraoperative technique and hemo-chylostasis. An air leak threshold of <20 ml/minute may be optimal to minimize chest tube reinsertions and reduce the failure rate.
Keywords: Chest Tubes, Robotic pulmonary resection, Lymphadenectomy, process improvement, Prospective
Received: 06 Oct 2025; Accepted: 11 Nov 2025.
Copyright: © 2025 McCormack, Phillips and Cerfolio. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ashley McCormack, ashley.lamparello@gmail.com
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