Safety and Short-Term Clinical Outcomes of Robot-Assisted Lobectomy Based on the Tubeless Concept for Early-Stage Lung Cancer: A Retrospective Cohort Study

AIM: The Tubeless comprehensive management model minimizes iatrogenic trauma by avoiding endotracheal intubation, chest tube placement, and urinary catheterization, while the robot-assisted thoracoscopic surgery system offers precise surgical manipulation and high-definition visualization. However, clinical evidence supporting the combination of these two approaches in early-stage lung cancer surgery remains limited. This study aimed to evaluate the short-term safety and clinical benefits of robot-assisted lobectomy based on the Tubeless concept in patients with early-stage lung cancer.METHODS: A total of 120 patients with early-stage non-small cell lung cancer who underwent robot-assisted lobectomy in our department between January 2022 and May 2025 were retrospectively analyzed. According to the perioperative management approach, patients were divided into the Tubeless group (n = 50), which received spontaneous breathing anesthesia without indwelling chest tubes or urinary catheters, and the traditional group (n = 70), which received double-lumen endotracheal intubation with indwelling chest tubes and urinary catheters. Baseline characteristics, intraoperative parameters, postoperative pain scores, postoperative complications, length of hospital stay, patient satisfaction, and 30-day readmission rates were compared between the two groups.RESULTS: No significant differences in baseline characteristics were observed between the two groups (p > 0.05). Similarly, no significant differences were observed in intraoperative blood loss, operative time, number of lymph node dissection stations, or total number of lymph nodes dissected (p > 0.05). Visual analogue scale (VAS) scores on postoperative days 1, 2, and 3 were significantly lower in the Tubeless group than in the traditional group (p < 0.05). The overall incidence of postoperative complications was significantly lower in the Tubeless group than in the traditional group (p = 0.04). Total hospital stay and postoperative hospital stay were significantly shorter in the Tubeless group than in the traditional group (p < 0.001). No significant difference was observed in the 30-day readmission rate between the two groups.CONCLUSIONS: Robot-assisted lobectomy combined with the Tubeless comprehensive management approach is feasible and is associated with favorable short-term perioperative outcomes in patients with early-stage lung cancer. However, long-term oncologic outcomes, such as recurrence-free and overall survival, require further investigation.