Cover
Volume 6, Issue 3 (2026) – 15 articles
Cover Picture: Tubeless Technique with Artificial Intelligence Empowerment: Advancing from "Enhanced Recovery" toward "Immediate Recovery" in Surgery.
Published in Artificial Intelligence Surgery (2026;6:365–373), this Perspective by Zhang et al. proposes a novel perioperative care framework that integrates Enhanced Recovery After Surgery (ERAS), tubeless surgical techniques, and artificial intelligence (AI) to advance recovery toward the concept of Immediate Recovery Surgery (IRS).
Although ERAS has substantially improved postoperative outcomes through multimodal perioperative management, conventional recovery pathways may not fully address physiological stressors arising during surgery, including endotracheal intubation, mechanical ventilation, deep sedation, and unnecessary invasive tubes. Building on advances in non-intubated video-assisted thoracoscopic surgery (VATS), the authors propose IRS as an ERAS-based extension designed to reduce selected iatrogenic stressors and enable carefully selected patients to resume essential functions, such as oral intake, communication, and mobilization, on the day of surgery.
AI serves as a complementary decision-support layer throughout the perioperative pathway. Before surgery, machine-learning models may improve patient selection and risk stratification. During surgery, AI-assisted closed-loop systems could help optimize sedation and analgesia while preserving spontaneous breathing. After surgery, predictive algorithms may facilitate early detection of complications and support individualized postoperative monitoring.
The authors also explore potential physiological benefits of tubeless approaches, including attenuated inflammatory responses, preservation of immune function, and reduced chronic postsurgical pain. However, these mechanisms remain partly hypothetical, and the available evidence is predominantly derived from thoracic surgery.
By integrating ERAS, tubeless techniques, and AI-enabled decision support, this framework offers a forward-looking perspective on personalized, data-driven perioperative care. The authors emphasize that its clinical benefits, safety, and applicability beyond thoracic surgery require further evaluation through prospective, multicenter studies and rigorous external validation of AI models.
Published in Artificial Intelligence Surgery (2026;6:365–373), this Perspective by Zhang et al. proposes a novel perioperative care framework that integrates Enhanced Recovery After Surgery (ERAS), tubeless surgical techniques, and artificial intelligence (AI) to advance recovery toward the concept of Immediate Recovery Surgery (IRS).
Although ERAS has substantially improved postoperative outcomes through multimodal perioperative management, conventional recovery pathways may not fully address physiological stressors arising during surgery, including endotracheal intubation, mechanical ventilation, deep sedation, and unnecessary invasive tubes. Building on advances in non-intubated video-assisted thoracoscopic surgery (VATS), the authors propose IRS as an ERAS-based extension designed to reduce selected iatrogenic stressors and enable carefully selected patients to resume essential functions, such as oral intake, communication, and mobilization, on the day of surgery.
AI serves as a complementary decision-support layer throughout the perioperative pathway. Before surgery, machine-learning models may improve patient selection and risk stratification. During surgery, AI-assisted closed-loop systems could help optimize sedation and analgesia while preserving spontaneous breathing. After surgery, predictive algorithms may facilitate early detection of complications and support individualized postoperative monitoring.
The authors also explore potential physiological benefits of tubeless approaches, including attenuated inflammatory responses, preservation of immune function, and reduced chronic postsurgical pain. However, these mechanisms remain partly hypothetical, and the available evidence is predominantly derived from thoracic surgery.
By integrating ERAS, tubeless techniques, and AI-enabled decision support, this framework offers a forward-looking perspective on personalized, data-driven perioperative care. The authors emphasize that its clinical benefits, safety, and applicability beyond thoracic surgery require further evaluation through prospective, multicenter studies and rigorous external validation of AI models.
