Evidence for ERAS within thoracic surgery (ERATS) is building. The key to enabling early recovery and ambulation is ensuring that postoperative pain is well controlled. Surgery on the chest is considered to be one of the most painful of surgical procedures for both open and minimally invasive surgery (MIS) approaches. Increasing use of MIS and improved perioperative care pathways has resulted in shorter length of stay (LOS), requiring patients to achieve optimal pain control earlier and meet discharge criteria sooner, sometimes on the same day as surgery. This requires optimizing pain control earlier in the postoperative recovery phase in order to enable ambulation and a better recovery profile, as well as to minimize the risk for development of chronic persistent postoperative pain (CPPP). This review will focus on the options for pain management protocols within an ERAS program for thoracic surgery patients (ERATS).

We present an ultrasound vibro-elastography system designed to acquire viscoelastic properties of the prostate and peri-prostatic tissue. An excitation stage imparts low-frequency (<20 Hz), limited amplitude (< ± 2mm), broadband vibratory motion to an endorectal transducer, along a radial/transversal direction. The induced tissue motion is estimated from ultrasound radio-frequency data and is used to estimate the mechanical frequency response of tissue to the excitation at different spatial locations. This can be used to determine the spatial distribution of various mechanical parameters of tissue, such as stiffness and viscosity. Phantom and in-vivo images are presented. The results obtained demonstrate high phantom and tissue linearity and high signal-to-noise ratio.

Post-lung resection air leaks remain one of the most common complications resulting in delay of hospital discharge (1). They result from an alveolar-pleural fistula, and in most instances, will heal spontaneously. Prolonged air leaks (PAL) have been defined as lasting more than 5 days after surgery (2). Despite multiple advances in lung resection, including the use of stapling devices, sealants and approaches without fissure dissection, thoracic surgeons continue to be plagued by air leaks. Over 50% of patients undergoing lung resection will have an air leak within the first 24 hours after surgery (2-4) and up to 15% of patients will have a PAL (5). Enhanced recovery after surgery (ERAS) programs must be designed to deal with air leaks in a systemic, evidencebased manner. Management of air leaks spans from the preoperative assessment to predict patients at high risk of PAL, intraoperative maneuvers to prevent parenchymal air leaks and postoperative management to reduce the duration of an air leak. This manuscript will focus on the two components of postoperative management of PAL: (I) accurate assessment of the air leak, and (II) management of a true alveolar-pleural fistula. Air leak assessment The accurate measurement of an air leak following lung resection has come to the forefront of ERAS programs. Traditional analogue devices only allow for a subjective static assessment of air leaks. Digital devices have allowed more objective measurements of air leaks by measuring

Despite improvement in TAUS technology, the accuracy for GB polyps remains poor. This needs to be considered when managing patients with TAUS-detected GB polyps. We recommend that the decision to operate on TAUS-detected GB polyps be largely based on symptoms, and following GB polyps with TAUS should be discouraged.