A chest tube after robotic thymectomy is unnecessary

Chest tubes are frequently placed after thymectomy, without data to support this common practice. We report our experience in eliminating them after robotic thymectomy.

This is a retrospective database review of patients who underwent robotic thymectomy performed by a single surgeon in which intraoperative chest tube insertion was not planned. Patient characteristics and postoperative outcomes are presented.

Between January 2018 and October 2022, 75 patients underwent robotic thymectomy performed by a single surgeon. Of those, 64 (85.3%) underwent a left-sided thoracic approach. The most common indication for resection was a suspicious anterior mediastinal mass. There were no conversions to an open operation. The median operative time was 72 minutes (range, 38-164 minutes), and the median estimated blood loss was 20 cc (range, 10-60 cc). Ten patients (13.3%) went home on the day of surgery, and all others (86.7%) were discharged on postoperative day 1. A chest tube was placed in 1 patient at time of closure because of a persistent air leak after extensive adhesiolysis from a prior thoracotomy; the tube was removed on the day of surgery after resolution of the air leak. No other patient required chest tube placement intraoperatively, immediately postoperatively, or within 60 days postoperation. Two patients underwent outpatient thoracentesis within 1 month postoperation for effusions. There were no 30- or 90-day mortality and no major morbidities.

A chest tube after robotic thymectomy is not necessary in almost all patients and can be safely omitted. The dogmatic routine practice of chest tube placement should be questioned.