Routine conventional leak test is not required for robotic major pulmonary resections

Area of Science:

• Thoracic Surgery
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Conventional air leak testing is standard practice in major pulmonary resections.
• The necessity of air leak testing in robotic-assisted procedures remains unclear.

Purpose of the Study:

• To evaluate the necessity of conventional air leak testing in robotic major pulmonary resections.
• To compare perioperative outcomes between thoracoscopic and robotic approaches for major lung resections.

Main Methods:

• Retrospective study of 578 patients undergoing minimally invasive major pulmonary resection (Feb 2019-Nov 2023).
• Comparison between thoracoscopic (n=471) and robotic (n=107) groups, with propensity score matching (n=100 each).
• Primary endpoint: drain removal rate on postoperative day (POD) 2 or later. Air leak testing was performed in thoracoscopic but not robotic cases.

Main Results:

• No significant difference in drain removal rate on POD 2 or later between thoracoscopic and robotic groups (p=0.011).
• In the robotic group, sealant application (p=0.002) and lobectomy (p=0.034) were significantly associated with later drain removal.

Conclusions:

• Robotic major lung resections can achieve comparable drain removal rates to thoracoscopic approaches without air leak testing.
• Air leak testing may not be essential for robotic pulmonary resections, but sealant use and lobectomy warrant consideration for drain management.