{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:57:43Z","timestamp":1787241463935,"version":"build-2736575974"},"reference-count":26,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>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 &lt; 0.001) and shorter hospital length of stay (20.0 vs. 52.0 h, p &lt; 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.<\/jats:p>","DOI":"10.3390\/jcm15166438","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T09:48:31Z","timestamp":1787219311000},"page":"6438","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Omitting Chest Tubes in Robotic Mediastinal Surgery: A Prospective, Protocol-Driven Analysis of Safety and Recovery"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9210-5851","authenticated-orcid":false,"given":"Mehlika","family":"\u0130\u015fcan","sequence":"first","affiliation":[{"name":"Ba\u015fak\u015fehir \u00c7am ve Sakura City Hospital, 34480 \u0130stanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7366-2772","authenticated-orcid":false,"given":"\u00d6mer","family":"Yavuz","sequence":"additional","affiliation":[{"name":"Ba\u015fak\u015fehir \u00c7am ve Sakura City Hospital, 34480 \u0130stanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reyhan","family":"Ertan","sequence":"additional","affiliation":[{"name":"Ba\u015fak\u015fehir \u00c7am ve Sakura City Hospital, 34480 \u0130stanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Yeginsu","sequence":"additional","affiliation":[{"name":"Ba\u015fak\u015fehir \u00c7am ve Sakura City Hospital, 34480 \u0130stanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1055\/s-0035-1549007","article-title":"Robotic-assisted thymectomy: Surgical procedure and results","volume":"63","author":"Rueckert","year":"2015","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_2","first-page":"18","article-title":"Multi-institutional European experience of robotic thymectomy for thymoma","volume":"5","author":"Marulli","year":"2016","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"68","DOI":"10.21037\/jovs.2017.05.01","article-title":"Robotic thymectomy","volume":"3","author":"Marulli","year":"2017","journal-title":"J. Vis. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1093\/ejcts\/ezr126","article-title":"The impact of chest tube removal on pain and pulmonary function after pulmonary resection","volume":"41","author":"Refai","year":"2012","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1111\/aas.12681","article-title":"Persistent postsurgical pain after video-assisted thoracic surgery-an observational study","volume":"60","author":"Wildgaard","year":"2016","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2226","DOI":"10.21037\/jtd.2016.08.02","article-title":"Tubeless video-assisted thoracoscopic surgery (VATS) under non-intubated, intravenous anesthesia with spontaneous ventilation and no placement of chest tube postoperatively","volume":"8","author":"Cui","year":"2016","journal-title":"J. Thorac. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1186\/s13019-024-03303-8","article-title":"Long-term outcomes of drainless anatomical lung resection surgery for pulmonary malignancies","volume":"20","author":"Kuo","year":"2025","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1055\/s-0039-1693027","article-title":"Omitting chest tube drainage after subxiphoid thoracoscopic thymectomy","volume":"68","author":"Xu","year":"2020","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"370","author":"Altman","year":"2007","journal-title":"Lancet"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1016\/S0140-6736(74)90884-8","article-title":"Measurement of pain","volume":"2","author":"Huskisson","year":"1974","journal-title":"Lancet"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1093\/bja\/aer195","article-title":"Determination of moderate-to-severe postoperative pain on the numeric rating scale: A cut-off point analysis applying four different methods","volume":"107","author":"Gerbershagen","year":"2011","journal-title":"Br. J. Anaesth."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1093\/ejcts\/ezy301","article-title":"Guidelines for enhanced recovery after lung surgery: Recommendations of the Enhanced Recovery After Surgery (ERAS\u00ae) Society and the European Society of Thoracic Surgeons (ESTS)","volume":"55","author":"Batchelor","year":"2019","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1093\/icvts\/ivab187","article-title":"Early discharge after thoracoscopic anatomical pulmonary resection for non-small-cell lung cancer","volume":"33","author":"Forster","year":"2021","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Kuo, S.-W., Su, Y.-H., and Chen, K.-C. (2024). Drainless uniportal VATS wedge resection for early non-small cell lung cancer: Propensity analysis of the effect of polyglycolic acid sheet (Neoveil\u2122). Diagnostics, 14.","DOI":"10.3390\/diagnostics14222586"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1097\/ALN.0b013e31828866b3","article-title":"Pain intensity on the first day after surgery: A prospective cohort study comparing 179 surgical procedures","volume":"118","author":"Gerbershagen","year":"2013","journal-title":"Anesthesiology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1186\/s13019-020-01102-5","article-title":"Is chest tube drainage necessary after subxiphoid thoracoscopic thymectomy?","volume":"15","author":"Li","year":"2020","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1687","DOI":"10.21037\/atm-21-5790","article-title":"Short-term analysis of uniport video-assisted thoracoscopic surgery via the subxiphoid approach without chest tube drainage for anterior mediastinal tumors: A comparative retrospective study","volume":"9","author":"Cao","year":"2021","journal-title":"Ann. Transl. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1711","DOI":"10.21037\/jtd.2018.02.11","article-title":"Subxiphoid and subcostal arch \u201cThree ports\u201d thoracoscopic extended thymectomy for myasthenia gravis","volume":"10","author":"Lu","year":"2018","journal-title":"J. Thorac. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1016\/j.xjon.2023.09.041","article-title":"A chest tube after robotic thymectomy is unnecessary","volume":"16","author":"McCormack","year":"2023","journal-title":"JTCVS Open"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"4101","DOI":"10.21037\/jtd.2019.10.04","article-title":"Expert consensus on tubeless video-assisted thoracoscopic surgery (Guangzhou)","volume":"11","author":"He","year":"2019","journal-title":"J. Thorac. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3880","DOI":"10.1007\/s00464-019-07035-y","article-title":"Defining the learning curve of robotic thoracic surgery: What does it take?","volume":"33","author":"Power","year":"2019","journal-title":"Surg. Endosc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1016\/j.athoracsur.2020.06.021","article-title":"Thoracic enhanced recovery after surgery: Single academic center observations after implementation","volume":"111","author":"Khoury","year":"2021","journal-title":"Ann. Thorac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"740","DOI":"10.21037\/atm-20-287","article-title":"Factors influencing the length of stay after mediastinal tumor resection in the setting of an enhanced recovery after surgery (ERAS)-TUBELESS protocol","volume":"8","author":"Wu","year":"2020","journal-title":"Ann. Transl. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1111\/1759-7714.14234","article-title":"Robot-assisted thoracic surgery versus video-assisted thoracic surgery for treatment of patients with thymoma: A systematic review and meta-analysis","volume":"13","author":"Shen","year":"2022","journal-title":"Thorac. Cancer"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1016\/j.athoracsur.2017.05.085","article-title":"Economic impact of an enhanced recovery pathway for lung resection","volume":"104","author":"Paci","year":"2017","journal-title":"Ann. Thorac. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Li, R., Qiu, J., Qu, C., Ma, Z., Wang, K., Zhang, Y., Yue, W., and Tian, H. (2022). Comparison of perioperative outcomes with or without routine chest tube drainage after video-assisted thoracoscopic pulmonary resection: A systematic review and meta-analysis. Front. 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