Enhanced recovery pathways in thoracic surgery: the Shanghai experience

Abstract

The attempts to implement the enhanced recovery (ER) program based on multiple specialties to minimize errors and complications in addition to speeding up the patient's treatment and recovery as much as possible. In China mainland, there is no unified hospital system and there are large differences between hospitals' results and protocols. The patient length of stay rate at the Shanghai Pulmonary Hospital (very high-volume referral hospital) is 7 days and may be considered a very good result compared to international rates. Perhaps thanks to these results may be due to our belief in the importance of minimally invasive approaches, and their positive effects on the patients and conduct as routinely as possible, in addition to starting to build our ER protocols. The patient should be involved in this program since his first visit to the clinic until the day he left the hospital after undergoing the operation.

Short-term outcomes of uniportal robotic-assisted thoracic surgery anatomic pulmonary resections: experience of Shanghai Pulmonary Hospital

“…Robotic-assisted thoracic surgery has been proven to A B C D be feasible and safe, with proponents citing improved instrument control, ergonomics and improved intraoperative views, which is especially helpful for complicated procedures (16,17). Since uni-portal VATS had been wildly accepted for decades (18)(19)(20), we attempted to perform uniportal RATS and succeeded in almost all kinds of major pulmonary resections, from segmentectomies to carinal sleeve resections (21)(22)(23)(24)(25). In this paper, we outline the results of our retrospective study examining the shortterm outcomes after U-RATS and B-RATS and share our experiences with the U-RATS technology.…”

Implementing a thoracic enhanced recovery with ambulation after surgery program: key aspects and challenges

“…Additional challenges unique to thoracic surgery include the physiologic insult caused by one lung ventilation intraoperatively and pain from intercostal incisions limiting respiratory effort. There are currently no consensus guidelines from the ERAS group for general thoracic surgery; however, several groups have published their initial experiences with enhanced recovery protocols (3)(4)(5)(6)(7)(8)(9)(10). Common elements include preoperative optimization with smoking cessation and preoperative exercise regimens, intraoperative care modifications with a focus on minimally invasive techniques, drain limitation, and long term narcotic avoidance.…”