Enhanced recovery after surgery in gynecologic surgery: perspectives and controversies from the 2026 ERAS World...

Enhanced recovery after surgery pathways have transformed perioperative care in gynecologic surgery, yet important questions remain regarding the value of individual pathway components, optimal implementation strategies, and the direction of future innovation. The Obstetrics and Gynecology Symposium at the 12th Enhanced Recovery After Surgery World Congress (Singapore, May 2026) convened international experts to debate the most contested and rapidly evolving topics in the field. This article summarizes the principal arguments and perspectives presented across three sessions. Session I examined the evidence base for current enhanced recovery after surgery practice through rapid-fire debates on four topics: the identification of low-value pathway components, the feasibility of opioid-free perioperative recovery, the evidence for structured prehabilitation, and the risks of universal early post-operative feeding. Session II addressed future directions through structured pro/con debates on whether artificial intelligence can replace enhanced recovery after surgery coordinators, whether randomized controlled trials should be the required standard for enhanced recovery after surgery evidence, and whether the home environment is a primary determinant of post-operative recovery. Session III broadened the perspective to global enhanced recovery after surgery, addressing racial and ethnic disparities in surgical outcomes, implementation opportunities in low- and middle-income countries, and key updates in the 2026 Enhanced Recovery After Surgery Society Gynecologic Oncology Guidelines. Collectively, these discussions underscored a shift from broad implementation toward precision perioperative care, with increasing emphasis on patient selection, implementation science, equity, and technological innovation. While consensus is emerging in some areas, substantial uncertainties remain. The debates presented at the congress establish a scholarly framework for future research and the continued evolution of enhanced recovery after surgery in gynecologic surgery.