Search Results (56)

Background and Clinical Significance: Serratus Anterior Muscle Pain Syndrome (SAMPS) is an underdiagnosed cause of anterior chest wall pain, often attributed to myofascial trigger points of the serratus anterior muscle (SAM) or dysfunction of the Long Thoracic Nerve (LTN), leading to significant disability and affecting ipsilateral upper limb movement and quality of life. Current diagnosis relies on exclusion and physical examination, with limited treatment options beyond conservative approaches. This case report presents a novel approach to chronic SAMPS, successfully diagnosed using Sonoguided Digital Palpation (SDP) and treated with ultrasound-guided hydrodissection of the LTN using 5% dextrose in water (D5W) without local anesthetic (LA), in a patient where conventional treatments had failed. Case Presentation: A 72-year-old male presented with a three-year history of persistent left chest pain radiating to the upper back, exacerbated by activity and mimicking cardiac pain. His medical history included two percutaneous coronary interventions. Physical examination revealed tenderness along the anterior axillary line and a positive hyperirritable spot at the mid axillary line at the 5th rib level. SDP was used to visualize the serratus anterior fascia (SAF) and LTN, and to reproduce the patient’s concordant pain by palpating the LTN. Ultrasound-guided hydrodissection of the LTN was then performed using 20–30cc of D5W without LA to separate the nerve from the surrounding tissues, employing a “fascial unzipping” technique. The patient reported immediate pain relief post-procedure, with the pain reducing from 9/10 to 1/10 on the Numeric Rating Scale (NRS), and sustained relief and functional improvement at the 12-month follow-up. Conclusions: Sonoguided Digital Palpation (SDP) of the LTN can serve as a valuable diagnostic adjunct for visualizing and diagnosing SAMPS. Ultrasound-guided hydrodissection of the LTN with D5W without LA may provide a promising and safe treatment option for patients with chronic SAMPS refractory to conservative management, resulting in rapid and sustained pain relief. Further research, including controlled trials, is warranted to evaluate the long-term efficacy and generalizability of these findings and to compare D5W to other injectates. Full article

Malignant mediastinal tumors are a group representing some of the most demanding oncological challenges for early, multi-level, and successful management. The timely identification of any suspicious clinical symptomatology is urgent in achieving an accurate, staged histological diagnosis, in order to follow up with an equally detailed medical therapeutic plan (interventional or not) and determine the principal goals regarding efficient overall treatment in these patients. We report a case of a 24-year-old male patient with an incident-free prior medical history. An initial chest X-ray was performed after the patient reported short-term, consistent moderate chest pain symptomatology, early work fatigue, and shortness of breath. The following imaging procedures (chest CT, PET-CT) indicated the presence of an anterior mediastinal mass (meas. ~11 cm × 10 cm × 13 cm, SUV: 8.7), applying additional pressure upon both right heart chambers. The Alpha-Fetoprotein (aFP) blood levels had exceeded at least 50 times their normal range. Two consecutive diagnostic attempts with non-specific histological results, a negative-for-malignancy fine-needle aspiration biopsy (FNA-biopsy), and an additional tumor biopsy, performed via mini anterior (R) thoracotomy with “suspicious” cellular gatherings, were performed elsewhere. After admission to our department, an (R) Video-Assisted Thoracic Surgery (VATS) was performed, along with multiple tumor biopsies and moderate pleural effusion drainage. The tumor’s measurements had increased to DMax: 16 cm × 9 cm × 13 cm, with a severe degree of atelectasis of the Right Lower Lobe parenchyma (RLL) and a pressure-displacement effect upon the Superior Vena Cava (SVC) and the (R) heart sinus, based on data from the preoperative chest MRA. The histological report indicated elements of a combined, non-seminomatous germ-cell mediastinal tumor, posthuberal-type teratoma, and embryonal carcinoma. The imminent chemotherapeutic plan included a “BEP” (Bleomycin^®/Cisplatin^®/Etoposide^®) scheme, which needed to be modified to a “VIP” (Cisplatin^®/Etoposide^®/Ifosfamide^®) scheme, due to an acute pulmonary embolism incident. While the aFP blood levels declined, even reaching normal measurements, the tumor’s size continued to increase significantly (DMax: 28 cm × 25 cm × 13 cm), with severe localized pressure effects, rapid weight loss, and a progressively worsening clinical status. Thus, an emergency surgical intervention took place via median sternotomy, extended with a complementary “T-Shaped” mini anterior (R) thoracotomy. A large, approx. 4 Kg mediastinal tumor was extracted, with additional RML and RUL “en-bloc” segmentectomy and partial mediastinal pleura decortication. The following histological results, apart from verifying the already-known posthuberal-type teratoma, indicated additional scattered small lesions of combined high-grade rabdomyosarcoma, chondrosarcoma, and osteosarcoma, as well as numerous high-grade glioblastoma cellular gatherings. No visible findings of the previously discovered non-seminomatous germ-cell and embryonal carcinoma elements were found. The patient’s postoperative status progressively improved, allowing therapeutic management to continue with six “TIP” (Cisplatin^®/Paclitaxel^®/Ifosfamide^®) sessions, currently under his regular “follow-up” from the oncological team. This report underlines the importance of early, accurate histological identification, combined with any necessary surgical intervention, diagnostic or therapeutic, as well as the appliance of any subsequent multimodality management plan. The diversity of mediastinal tumors, especially for young patients, leaves no place for complacency. Such rare examples may manifest, with equivalent, unpredictable evolution, obliging clinical physicians to stay constantly alert and not take anything for granted. Full article

Objectives: New smartphone-based methods for measuring cervical spine range of motion (CS-ROM) and posture are emerging. The purpose of this study was to assess the reliability and validity of three such methods in patients with non-specific chronic neck pain (NSCNP). Methods: The within-day test–retest reliability of CS-ROM and forward head posture (craniovertebral angle-CVA) was examined in 45 patients with NSCNP. CS-ROM was simultaneously measured with an accelerometer sensor (KFORCE Sens^®) and a mobile phone device (iHandy and Compass apps), testing the accuracy of each and the parallel-forms reliability between the two methods. For construct validity, correlations of CS-ROM with demographics, lifestyle, and other cervical and thoracic spine biomechanically based measures were examined in 90 patients with NSCNP. Male–female differences were also explored. Results: Both methods were reliable, with measurements concurring between the two devices in all six movement directions (intraclass correlation coefficient/ICC = 0.90–0.99, standard error of the measurement/SEM = 0.54–3.09°). Male–female differences were only noted for two CS-ROM measures and CVA. Significant associations were documented: (a) between the six CS-ROM measures (R = 0.22–0.54, p < 0.05), (b) participants’ age with five out of six CS-ROM measures (R = 0.23–0.40, p < 0.05) and CVA (R = 0.21, p < 0.05), (c) CVA with two out of six CS-ROM measures (extension R = 0.29, p = 0.005 and left-side flexion R = 0.21, p < 0.05), body mass (R = −0.39, p < 0.001), body mass index (R = −0.52, p < 0.001), and chest wall expansion (R = 0.24–0.29, p < 0.05). Significantly lower forward head posture was noted in subjects with a high level of physical activity relative to those with a low level of physical activity. Conclusions: The reliability of both CS-ROM methods was excellent. Reductions in CS-ROM and increases in CVA were age-dependent in NSCNP. The significant relationship identified between CVA and CWE possibly signifies interconnections between NSCNP and the biomechanical aspect of dysfunctional breathing. Full article

Background/Objectives: The long-term sequelae of COVID-19 pneumonia, particularly the persistence of imaging abnormalities and their relationship to clinical symptoms, remain unclear. While the acute radiologic patterns are well-documented, the transition to chronic pulmonary changes—and their implications for long COVID symptoms—require systematic investigation. Methods: Our study included 93 patients with moderate to severe COVID-19 pneumonia who were admitted to Istanbul Medical Faculty Hospital, each having one follow-up CT scan over a ten-month period. Two thoracic radiologists independently calculated semi-quantitative initial chest CT scores to evaluate lung involvement in pneumonia (0–5 per lobe, total score 0–25). Two radiologists and one pulmonologist retrospectively examined the persistence of follow-up imaging findings, interpreting them alongside the relevant clinical and laboratory data. Additionally, in a subcohort (n = 46), mid-term (5–7 months) and long-term (≥10 months) scans were compared to assess temporal trajectories. Results: Among the 93 patients with long-term follow-up imaging, non-fibrotic changes persisted in 34 scans (36.6%), while fibrotic-like changes were observed in 70 scans (75.3%). The most common persistent non-fibrotic changes were heterogeneous attenuation (29%, n = 27) and ground-glass opacities (17.2%, n = 16), and the persistent fibrotic-like changes were pleuroparenchymal bands or linear atelectasis (58%, n = 54), fine reticulation (52.6%, n = 49), and subpleural curvilinear lines (34.4%, n = 32). Both persistent non-fibrotic and fibrotic-like changes were statistically correlated with the initial CT score (p < 0.001), LDH (p < 0.001), and ferritin levels (p = 0.008 and p = 0.003, respectively). Fatigue (p = 0.025) and chest pain (p < 0.001) were reported more frequently in patients with persistent non-fibrotic changes, while chest pain (p = 0.033) was reported more frequently among those with persistent fibrotic-like changes. Among the 46 patients who underwent both mid- and long-term follow-up imaging, 47.2% of those with non-fibrotic changes (17 out of 36) and 10% of those with fibrotic-like changes (4 out of 40) exhibited regression over the long term. Conclusions: Initial imaging and laboratory findings may indicate persistent imaging findings related to long-term sequelae of COVID-19 pneumonia. Many of these persistent imaging abnormalities, particularly non-fibrotic changes seen in the mid-term, tend to lessen over the long term. A correlation exists between persistent imaging findings and clinical outcomes of long COVID-19, underscoring the need for further research. Full article

This study involves 32 adults with upper cross syndrome (UCS). The experimental group was asked to perform scapular stabilization accompanied by breathing training (SBG). The comparison group was asked to perform scapular stabilization accompanied by thoracic exercises (STG). After four weeks of exercise, changes in the pressure pain threshold (PPT), respiration function, and lower chest expansion (LCE) were measured again. Methods: A two-way repeated-measures analysis of variance (ANOVA) was conducted to investigate the interaction between the measurement period and measurement group, as well as the intra-group effect throughout the measurement period. The statistical significance level was set at p < 0.05. Bonferroni post hoc corrections were used to analyze the intra-group differences before and after the effect of the interventions (α = 0.025). Results: A significant difference in within-group effect validation was found when comparing the time of change between the two groups before and after the intervention. There was no significant difference in the interaction effect depending on the time and group (p > 0.025). Conclusions: Scapular stabilization combined with breathing training or thoracic exercises effectively reduces pain and improves respiratory function in upper cross syndrome. Full article

Video-assisted thoracoscopic surgery (VATS) is a minimally invasive diagnostic and therapeutic procedure utilized in various thoracic conditions. VATS has grown in popularity with ever-expanding knowledge of enhanced recovery after surgery (ERAS) protocols and its benefits regarding patient care and outcomes. Pain control following VATS is of utmost importance to minimize the complication risk. Options for pain control following VATS have traditionally included systemic IV analgesia but have evolved to include loco-regional analgesia as well. The serratus anterior plane block (SAPB) is one form of loco-regional analgesia utilized in VATS that has been shown to provide effective pain control of the anterolateral chest wall. Patients who received SAPB compared to control methods of anesthesia demonstrated significant decreases in postoperative pain and postoperative opioid consumption. SAPB is effective and offers a promising safety profile as the block is typically more superficial than other types of loco-regional analgesia. This review outlines the recent literature surrounding the use of SAPB for pain control in VATS. Full article

Background/Objectives: Primary chest wall tumors or malignancies of adjacent organs with chest wall infiltration present a significant challenge for surgical resection and reconstruction. Larger defects involving the sternum, resections in the area of the thoracic apertures, or those near the spine are difficult to reconstruct. The reconstruction has to ensure stability, to prevent paradoxical movements and lung herniation, while also achieving a satisfactory cosmetic result. The “spider web” technique restores chest wall stability by creating a web-like framework made of non-resorbable threads fixed to adjacent bony structures. Additionally, a synthetic mesh is placed over the web construct, and both layers are covered with muscles (local muscles or different types of flaps). In this prospective study, clinical data from patients who underwent surgery using the “spider web” technique were analyzed with respect to chest wall stability, procedure-specific complications, pulmonary function, and patient satisfaction. Methods: A total of 16 patients receiving 18 chest wall resections and reconstructions using the “spider web” technique were followed for at least one year. Chest wall stability and lung function (FEV1 and DLCO) were assessed. Quality of life, cosmetic satisfaction, potential functional impairment, and analgesic consumption were measured using a modified EORTC QLQ-C30 questionnaire. Results: The follow-up period ranged from 12 to 32 months. In all cases, optimal chest wall stability was maintained without impairment of respiratory mechanics. Procedure-specific complications occurred in five cases (27.8%), including seroma (one case), hematoma (two cases), necrosis at the TRAM flap donor site (one case), and mesh infection (one case), all of which were resolved without further complications. Postoperative FEV1 and DLCO were not significantly reduced compared with preoperative values. The global health status score for quality of life was 60 ± 27 points. Nine patients reported being able to ascend at least one floor of stairs without shortness of breath and half of the patients were able to participate in sports activities. One patient required prolonged analgesic medication due to chronic pain. In all cases, patients were satisfied with the cosmetic result. Both 30-day and 90-day mortality were 0%. No local recurrence at the chest wall reconstruction site occurred. Conclusions: The “spider web” technique is a highly suitable method for chest wall reconstruction, allowing covering all types of chest wall defects, regardless of size and location. This cost-effective technique not only provides optimal stability but also good functional results. Full article

Background. Thoracic endometriosis is thought to be the most common form of endometriosis occurring outside of the pelvis. We aimed to characterize thoracic symptoms of endometriosis in a population of patients not necessarily suffering from catamenial pneumothorax, which is most commonly identified as a symptom of thoracic endometriosis. Material and methods. We used a web-based survey addressed to users of two Polish endometriosis patient advocate organizations. The factor that qualified patients for the study was the presence of symptoms in the chest related to the menstrual cycle. Results. A total of 92 respondents were questioned. In this group, 96% (88/92) of patients were previously diagnosed with pelvic endometriosis, 20% (18/92) with thoracic endometriosis, and 18% (17/92) with diaphragmatic endometriosis. The percentage of patients diagnosed with both thoracic and diaphragmatic endometriosis was 15% (14/92). Ninety-eight percent of patients suffered from pain. The four most common symptoms reported by patients were chest pain, dyspnea, cough, and stunned limb, occurring in 96%, 67%, 52%, and 33%, respectively. The feeling of a stunned, weakened limb occurs in older women at 38.4 vs. 35.5 years of age (p = 0.021). There is a trend that women who suffer pain (36.7 vs. 31.3 years of age p = 0.053) and hemoptysis (41.0 vs. 36.2 years of age p = 0.059) are older than women without these symptoms. We identified two unique symptoms of thoracic endometriosis—pouring liquid sensation (13%) and popping sensation (12%)—which can be related to a small amount of gas and fluid in the pleural cavity. Conclusions. Patients who have endometriosis suffer from a constellation of thoracic symptoms related to menses. Full article

Background: Emphysema is a chronic lung disease characterized by alveolar wall destruction, leading to impaired gas exchange. Giant bullous emphysema (GBE) is a severe form of emphysema, often requiring surgical intervention. Video-assisted thoracoscopic surgery (VATS) is a minimally invasive approach for various thoracic pathologies, including lung volume reduction surgery (LVRS) and bullectomy for emphysematous bullae. Uniportal VATS (U–VATS), a further refinement, offers benefits such as reduced postoperative pain and faster recovery. Methods: This retrospective study analyzed data from two high-volume European Thoracic Surgery centers between August 2016 to January 2024. A total of 29 patients underwent U–VATS bullectomy for GBE. Results: Nineteen patients were males (65.5%) with a mean age of 44.7 ± 8.8 years. Ten (34.5%) were active smokers. Eighteen patients (62.1%) presented with a single giant bulla, while the remaining cases were in the context of pulmonary emphysema. Four patients (13.8%) presented with pneumothorax, with one requiring preoperative chest drainage. Twenty-eight patients (96.6%) underwent only U–VATS bullectomy, with additional chemical pleurodesis in eleven cases (37.9%). One patient (3.4%) underwent a left upper lobectomy for a giant bulla and NSCLC. In cases of severe lung emphysema and fragile pulmonary tissue, the stapler line was buttressed with Gore^® Seamguard^®. No conversions to thoracotomy, postoperative air-leaks, or major complications were recorded. At a mean follow-up time of 22.0 ± 14.0 months, no pneumothorax recurrence was documented. At about six months after surgery, pulmonary function significantly improved. Conclusions: U–VATS bullectomy appears to be a safe and feasible technique for the treatment of bullae in GBE, offering promising postoperative outcomes. Full article

Background/Objectives: Effective pain management in polytrauma patients with rib fractures is essential, particularly in the critical care setting. While epidural analgesia is considered the gold standard, it is not always feasible, necessitating alternative locoregional approaches. We present the case of a polytrauma patient with multiple, bilateral rib fractures and severe chest pain that hindered weaning from mechanical ventilation. A bilateral Serratus Anterior Plane Block (SAPB) was performed, with catheters placed for continuous administration of local anesthetics. Pain relief was immediate, enabling a rapid weaning from mechanical ventilation, safe extubation, and subsequent discharge to rehabilitation. A review of the literature on this technique in critically ill patients with thoracic trauma and multiple rib fractures is also presented. Methods: We conducted a literature search up to November 2024, identifying studies evaluating the use of SAPB in critically ill patients with chest trauma and rib fractures. Results: Eight studies were identified, including a total of 197 cases, of which only 3 involved a bilateral SAPB. Studies and published case reports demonstrated significant variability in analgesic protocols and reported outcomes. Notably, only two papers addressed specifically its role in facilitating weaning from mechanical ventilation. Conclusions: Pain control is fundamental in managing severe chest trauma. This case and the reviewed literature suggest that the SAPB is a promising option when epidural analgesia is contraindicated or impractical. However, further studies are needed to define its place in clinical practice and optimize its use in critically ill patients. Full article

Background: Minimally invasive thoracic surgery has advanced since the introduction of multiportal video-assisted thoracoscopic surgery (mVATS) in 1991. Primary spontaneous pneumothorax (PSP) is an ideal condition for refining minimally invasive techniques owing to its straightforward procedures and predictable bullae distributions. Methods: Uniportal VATS (uVATS), which involves a single incision, is an alternative to mVATS, offering reduced postoperative pain, lower paresthesia rates, and comparable recurrence outcomes. This review explores two main uVATS approaches: intercostal and subxiphoid. Results: The intercostal approach is common to surgeons trained in mVATS, easier to adopt, and provides excellent cosmetic outcomes. Innovations such as the chest wall pulley method and anchoring sutures further enhance its operability and prevent recurrence. Subxiphoid uVATS minimizes intercostal nerve damage and postoperative pain, making it advantageous for bilateral PSP surgeries. However, it poses challenges such as longer operative times and limited dorsal visualization. Emerging strategies, including drainless postoperative management and two-lung ventilation with CO₂ insufflation, have reduced surgical invasiveness. Additionally, cosmetic techniques such as subaxillary incisions enhance patient satisfaction. Conclusions: uVATS continues to redefine PSP surgery, prioritize patient-centered outcomes, and integrate novel strategies to achieve superior results. Full article

Cardiac surgery is continuously evolving, with increasing skills required by the cardiac anaesthesiologist. Following the advent of intraoperative echocardiography, we are witnessing a potential new revolution for the cardiac anaesthesiologist. A new era has indeed started with the implementation of thoracic fascial blocks (TFBs) in the field of cardiac surgery. TFBs provide several advantages in the context of multimodal analgesia, with improved pain control and reduction of the side effects related to large doses of opioids. We envisage that implementation of TFBs is likely to become a pivotal concept in the field of enhanced recovery after cardiac surgery. We describe the main TFBs for the anterior and/or antero-lateral chest wall, and their peculiar use in cardiac surgery. In particular, we discuss indications and tips and tricks to enhance clinical results for the following blocks: (1) Pecto-Intercostal Plane (superficial and deep); (2) Rectus Sheath; (3) Interpectoral Plane and Pectoserratus Plane; (4) Serratus Anterior Plane; (5) Erector Spinae Plane. Nonetheless, the scientific evidence for the use of TFBs in the field of cardiac anaesthesia is not robust yet, mostly based on small-sized single-centre studies, making it difficult to achieve a high quality of evidence. Further, it remains unclear which cardiac surgery patients may benefit the most from these techniques. Full article

The evolution of regional anesthesia techniques has markedly influenced the management of postoperative pain, particularly in thoracic surgery. As part of a multimodal analgesic approach, fascial plane blocks have gained prominence due to their efficacy in providing targeted analgesia with minimal systemic side effects. Among these, the superficial intercostal plane (SPIP) block and deep parasternal intercostal plane (DPIP) block are of notable interest. The aim of this study was to investigate the dye spread to the anterior chest wall space and its spread pathway through anatomical morphometric analyses on cadavers for single-injection and double-injection SPIP blocks versus DPIP blocks. In both qualitative and quantitative evaluations, the single-injection SPIP block with 10 mL of dye demonstrated a broader and more extensive spread compared to the double-injection SPIP block, which used 5 mL of dye per injection site (p < 0.05), and the DPIP block with 10 mL of dye (p < 0.05). All the blocks had a positive correlation between the distances from the sternum border and the area of dye spread, suggesting that the crucial role of volume in fascial blocks is that it significantly affects the opening of the fascial compartment, enabling optimal spread of the anesthetic. Adequate volume facilitates proper spread and diffusion across the fascial plane, ensuring more comprehensive fascia coverage and thus enhancing the block’s effectiveness. Finally, precise volume management is key to maximizing both efficacy and safety. Full article

Background: Endometriosis is a systemic, inflammatory, estrogen-dependent condition characterized by endometrial stroma and gland-like lesions outside of the uterus. It causes a range of symptoms, notably chronic pelvic pain, infertility and organ dysfunction. Thoracic endometriosis syndrome (TES) has been described as endometriosis that is found in the lung parenchyma, pleura and diaphragm. It may be asymptomatic or present with symptoms of catamenial pneumothorax, hemothorax, hemoptysis, isolated chest pain, shoulder pain or findings of lung nodules. Aim: The aim of this review is to provide a comprehensive overview of thoracic endometriosis syndrome (TES), including its clinical presentation, diagnostic challenges, and current management strategies. This review aims to highlight the importance of a multidisciplinary approach in the treatment of TES, emphasizing conservative management and the role of minimally invasive surgical techniques for refractory cases. Conclusions: Thoracic endometriosis syndrome appears to be a marker of severe endometriosis. As much as possible, the patient with TES is managed conservatively, with surgery reserved for refractory cases. When surgery is recommended, the procedure is conducted through a multidisciplinary minimally invasive approach, with video-assisted thoracoscopic surgery (VATS) and video-assisted laparoscopy. Meticulous intraoperative survey, the removal of endometriosis implants with and without robotic assistance and post-operative hormonal therapy may be recommended to prevent recurrence. Full article

Background: Despite the implementation of enhanced recovery programs, the reported average postoperative length of stay after robotic lobectomy remains as 4 days. In this prospective study, we present the outcomes of early discharge (on day 2) with telehealth home monitoring device after robotic lobectomy for lung cancer in selected patients. Methods: All patients with a caregiver were discharged on postoperative day 2 (POD 2) with a telemonitoring device provided they met the specific discharge criteria. Inclusion criteria: <75 years old, stage I-II NSCLC, with caregiver, ECOG 0–2, scheduled for lobectomy, logistic proximity to hospital (<60 km); intra-postoperative exclusion criteria: conversion to open surgery, early complications needing hospital monitoring or redo-operation, difficult pain management, <92 HbO2% saturation on room air or need for O2 supplementation, altered vital or laboratory parameters. Teleconsultations were scheduled as follows: the first one in afternoon of POD2, two on POD3, then once a day until chest tube removal. After discharge, patients recorded their vital signs at least four times a day using the device, which allowed two surgeons to monitor them via a mobile application. In the event of sudden changes in vital signs or the occurrence of adverse events, patients had access to a direct phone line and a dedicated re-hospitalization pathway. The primary outcome was safety, assessed by the occurrence of post-discharge complications or readmissions, as well as feasibility. Secondary outcomes: comparison of safety profile with a matched control group in which the standard of care and the evaluation of resource optimization were maintained and economic evaluation. Results: Between July 2022 and February 2024, 48 patients were enrolled in the present study. Six patients (12.5%) dropped out due to unsatisfied discharge criteria on POD2. Exclusion causes were: significant air leaks (n:2) requiring monitoring and the use of suction device, uncontrolled pain (n:2), atrial fibrillation, and occurrence of cerebral ischemia (n:1 each). The adherence rate to vital signs monitoring by patients was 100%. A mean number of four measurements per day was performed by each patient. During telehealth home monitoring, a total of 71/2163 (1.4%) vital sign measurements violated the established acceptable threshold in 22 (52%) patients. All critical violations were managed at home. During the surveillance period (defined as the time from POD 2 to the day of chest tube removal), a persistent air leak was recorded in one patient requiring readmission to the hospital (on POD 13) and re-intervention with placement of a second thoracic drainage due to unsatisfactory lung expansion. No other postoperative complication occurred nor was there any readmission needed. Compared to the control group, the discharge gain was 2.5 days, with an economic benefit of 528 €/day (55.440 € on the total enrolled population). Conclusions: Our results confirm that the adoption of telehealth home monitoring is feasible and allows a safe discharge on postoperative day two after robotic surgery for stage I-II NSCLC in selected patients. A potential economic benefit (141 days of hospitalizations avoided) for the healthcare system could result from the adoption of this protocol. Full article