title: Fast-track video-assisted thoracoscopic surgery: future challenges.
abstract: OBJECTIVE
  To provide a short overview of fast-track video-assisted thoracoscopic surgery (VATS) and to identify areas requiring further research.
  
  
  METHODS
  A literature search was made using key words including: fast-track, enhanced recovery, video-assisted thoracoscopic surgery, robot-assisted thoracoscopic surgery (RATS), robotic, thoracotomy, single-incision, uniportal, natural orifice transluminal endoscopic surgery (NOTES), chest tube, air-leak, digital drainage, pain management, analgesia, perioperative management, anaesthesia and non-intubated. References from articles were screened for further articles. Using abstracts, areas of interest for developing a fast-track protocol were selected.
  
  
  RESULTS
  The minimally invasive approach can be divided into several surgical methods that need further research to establish superiority. The role of intubation has to be further examined as well as the role of chest drains. Multimodal analgesic treatment including preoperative methylprednisolone seems promising and requires further research.
  
  
  CONCLUSIONS
  The fast-track data from other procedures may support future development and improvement of fast-track VATS.
authors.affiliation: a Department of Cardiothoracic Surgery , Rigshospitalet, Copenhagen University , Copenhagen , Denmark ;|b Department of Surgical Pathophysiology , Rigshospitalet, Copenhagen University , Copenhagen , Denmark.
authors.forename: Bo Laksáfoss
authors.initials: BL
authors.lastname: Holbek
authors.affiliation: a Department of Cardiothoracic Surgery , Rigshospitalet, Copenhagen University , Copenhagen , Denmark ;
authors.forename: René
authors.initials: R
authors.lastname: Horsleben Petersen
authors.affiliation: b Department of Surgical Pathophysiology , Rigshospitalet, Copenhagen University , Copenhagen , Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Kehlet
authors.affiliation: a Department of Cardiothoracic Surgery , Rigshospitalet, Copenhagen University , Copenhagen , Denmark ;
authors.forename: Henrik Jessen
authors.initials: HJ
authors.lastname: Hansen
mesh_terms: D005544:Forecasting; D006801:Humans; D007902:Length of Stay; D011013:Pneumonectomy / Q000009:adverse effects / Q000534:rehabilitation* / Q000639:trends; D011182:Postoperative Care / Q000379:methods* / Q000639:trends; D020127:Recovery of Function; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000534:rehabilitation* / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
keywords: Analgesia; comorbidity; perioperative care; postoperative complications; robotic surgical procedures; video-assisted thoracoscopic surgery