Tubeless minimally invasive treatment: taking a new step in enhanced recovery after surgery (ERAS)

To the editor: We read with great interest the paper by Cui and colleagues where the authors compared the results of the application of two different chest tube management systems after video-assisted thoracoscopic (VATS) lobectomy. This proved that chest tube management plays a key role in enhanced recovery after lobectomy surgery (ERAS) and also showed a significant impact on patients treated with a minimally invasive surgical approach by using a drainage ball with negative pressure compared with the commonly used chest tube. Here, we summarize the new approaches used in ERAS with a perioperative regime optimization including the new suggested chest tube drainage. The concept of ERAS is well known by physicians and its implementation requires a combination of minimally invasive surgical techniques. Over the past three decades, the collaboration between the clinical practice of the ERAS concept and minimally invasive surgery has been greatly developed through collaboration with multidisciplinary teams. Tubeless minimally invasive treatment includes no intraoperative tracheal intubation during patient anesthesia, no urinary catheter placement during the operation and no chest tube after the operation. If these aspects of perioperative care regime optimization and all-in-one model in medical care were linked-up, minimally invasive treatment with ERAS could be realized. Thoracoscopic surgery was a milestone in thoracic surgery. The concept of ERAS in thoracoscopic surgery involves the foundation of pain and risk-free wards during the perioperative period and improving the patient’s quality of life post discharge, including multimodal analgesia, minimizing the perioperative period to avoid the placement of excessive drainage tubes and patient transfusion, at the same time strengthening postoperative care and rehabilitation which is the goal of tubeless minimally invasive treatment.