Devising the guidelines: the techniques of uniportal video-assisted thoracic surgery-postoperative management and enhanced recovery after surgery

Kehlet first introduced the notion of enhanced recovery after surgery (ERAS). Moreover, in the last years, the fast-track programmes demonstrated a reduction of complications and the hospital length of stay in general surgery. ERAS involves a multidisciplinary to development the value of care introducing the evidence-based knowledge into practice. ERAS has spread to other surgical specialities, showing the same improvements regarding clinical outcomes and costs. Therefore, there are numerous guidelines official published by the ERAS Society for many specialities, and many meta-analyses recognised the benefits of ERAS. ERAS pathways have demonstrable advantages in some specialities such as colorectal surgery. There is emerging evidence of ERAS efficacy in thoracic surgery. ERAS is safe and not increase postoperative morbidities, and ERAS guidelines should encourage future researches to address current knowledge gaps. Nevertheless, further prospective and randomised studies on the ERAS protocol, including the ones based on the uniportal video-assisted thoracic surgery (UniVATS), and focussing more on longitudinal outcomes over costs will be necessary. In fact, in the era of minimally invasive surgery traditional findings may not be appropriate to capture all benefits provided by ERAS. There is, therefore, a need to switch focus to endpoints linked to value in health care and patient centred efficiency.