Intraoperative nasogastric tube in robotic thoracic surgery: lower gastrointestinal risk without added respiratory risk

Gastrointestinal (GI) complications are a leading cause of postoperative morbidity in thoracic surgery patients. Robotic thoracic surgery, with CO2 insufflation, may heighten GI risks, such as ileus or bowel obstruction. Intraoperative nasogastric tube (iNGT) use has the potential to mitigate these risks by reducing gastric content and preventing aspiration. This retrospective study evaluated the impact of iNGT on postoperative GI and respiratory complications in 718 patients undergoing robotic anatomical lung resections from 2017 to 2022. Patients were divided into iNGT (n = 450) and non-iNGT (n = 268) groups. GI complications were significantly lower in the iNGT group (1.8 vs. 10%, p < 0.0001), with an adjusted odds ratio of 5.85 for non-iNGT patients. No significant difference was observed in respiratory complications (19.3 vs. 18.6%, p = 0.82). These findings suggest that iNGT reduces GI complications without increasing respiratory risks, supporting its selective use in robotic thoracic surgery.