Omitting Chest Tubes in Robotic Mediastinal Surgery: A Prospective, Protocol-Driven Analysis of Safety and Recovery

Background: Routine chest tube placement remains common in robotic mediastinal surgery despite its association with postoperative pain. We evaluated the safety and feasibility of a protocol-driven no-drain strategy for robotic mediastinal lesion resection. Methods: This prospective study analyzed 39 consecutive procedures performed in 38 patients. A strict intraoperative safety protocol, including a submerged air leak test, was utilized to determine drain omission. Procedures were categorized into no-drain (n = 21) and drain (n = 18) groups based on protocol adherence. Results: The no-drain strategy was implemented in 53.8% of procedures, including complex cases such as thymomas and large lesions (up to 160 mm). The no-drain group was associated with lower median VAS pain scores at 12 h (2.0 vs. 5.0, p < 0.001) and shorter hospital length of stay (20.0 vs. 52.0 h, p < 0.001). No patient in the no-drain group required reintervention for residual pneumothorax. Conclusions: Omitting chest tubes using a standardized safety protocol is feasible and safe in appropriately selected patients. This strategy was associated with lower postoperative pain and a shorter hospital stay, supporting the feasibility of a short-stay recovery pathway after robotic mediastinal surgery.