{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T13:47:04Z","timestamp":1788184024296,"version":"build-2803163510"},"reference-count":30,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,2,10]],"date-time":"2023-02-10T00:00:00Z","timestamp":1675987200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"\u201cFinanziamento 5 \u00d7 1000 Ministero della Salute\u201d"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Despite the adoption of enhanced recovery programs, the reported postoperative length of stay after robotic surgery is 4 days even in highly specialized centers. We report preliminary results of a pilot study for a new protocol of early discharge (on day 2) with telehealth home monitoring after robotic lobectomy for lung cancer. All patients with a caregiver were discharged on postoperative day 2 with a telemonitoring device if they satisfied specific discharge criteria. Teleconsultations were scheduled once in the afternoon of post-operative day 2, twice on postoperative day 3, and then once a day until the chest tube removal. Post-discharge vital signs were recorded by patients at least four times daily through the device and were available for consultation by two surgeons through phone application. In case of sudden variation of vital signs or occurrence of adverse events, a direct telephone line was available for patients as well as a protected re-hospitalization path. Primary outcome was the safety evaluated by the occurrence of post-discharge complications and readmissions. Secondary outcome was the evaluation of resources optimization (hospitalization days) maintaining the standard of care. During the study period, twelve patients satisfied all preoperative clinical criteria to be enrolled in our protocol. Two of twelve enrolled patients were successively excluded because they did not satisfy discharge criteria on postoperative day 2. During telehealth home monitoring a total of 27\/427 vital-sign measurements violated the threshold in seven patients. Among the threshold violations, only 1 out of 27 was a critical violation and was managed at home. No postoperative complication occurred neither readmission was needed. A mean number of three hospitalization days was avoided and an estimated economic benefit of about EUR 500 for a single patient was obtained if compared with patients submitted to VATS lobectomy in the same period. These preliminary results confirm that adoption of telemonitoring allows, in selected patients, a safe discharge on postoperative day 2 after robotic surgery for early-stage NSCLC. A potential economic benefit could derive from this protocol if this data will be confirmed in larger sample.<\/jats:p>","DOI":"10.3390\/cancers15041146","type":"journal-article","created":{"date-parts":[[2023,2,13]],"date-time":"2023-02-13T01:48:56Z","timestamp":1676252936000},"page":"1146","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Early Hospital Discharge on Day Two Post Robotic Lobectomy with Telehealth Home Monitoring: A Pilot Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7585-5754","authenticated-orcid":false,"given":"Edoardo","family":"Bottoni","sequence":"first","affiliation":[{"name":"Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Mangiameli","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy"},{"name":"Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Testori","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9589-1891","authenticated-orcid":false,"given":"Federico","family":"Piccioni","sequence":"additional","affiliation":[{"name":"Anesthesia Unit 1, Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica Maria","family":"Giudici","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9091-6797","authenticated-orcid":false,"given":"Emanuele","family":"Voulaz","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy"},{"name":"Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia","family":"Ruggieri","sequence":"additional","affiliation":[{"name":"Anesthesia Unit 1, Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Dalla Corte","sequence":"additional","affiliation":[{"name":"Anesthesia Unit 1, Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4342-0860","authenticated-orcid":false,"given":"Alessandro","family":"Crepaldi","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Goretti","sequence":"additional","affiliation":[{"name":"Quality Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4928-3550","authenticated-orcid":false,"given":"Elena","family":"Vanni","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy"},{"name":"Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Pisarra","sequence":"additional","affiliation":[{"name":"Quality Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy"},{"name":"Department of Economics, Management and Quantitative Methods, University of Milan, Via Conservatorio 7, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umberto","family":"Cariboni","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Alloisio","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy"},{"name":"Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4376-6538","authenticated-orcid":false,"given":"Maurizio","family":"Cecconi","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy"},{"name":"Anesthesia Unit 1, Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1093\/ejcts\/ezv154","article-title":"Video-assisted thoracoscopic surgery versus open lobectomy for primary non-small-cell lung cancer: A propensity-matched analysis of outcome from the European Society of Thoracic Surgeon database","volume":"49","author":"Falcoz","year":"2015","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1093\/ejcts\/ezy301","article-title":"Guidelines for enhanced recovery after lung surgery: Recommendations of the Enhanced Recovery After Surgery (ERASVR) Society and the European Society of Thoracic Surgeons (ESTS)","volume":"55","author":"Batchelor","year":"2019","journal-title":"Eur. J. Cardiothorac Surg."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Patel, Y.S., Hanna, W.C., Fahim, C., Shargall, Y., Waddell, T.K., Yasufuku, K., Machuca, T.N., Pipkin, M., Baste, J.-M., and Xie, F. (2022). RAVAL trial: Protocol of an international, multi-centered, blinded, randomized controlled trial comparing robotic-assisted versus video-assisted lobectomy for early-stage lung cancer. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0261767"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1186\/s40880-016-0117-z","article-title":"Long-term survival of early-stage non-small cell lung cancer patients who underwent robotic procedure: A propensity score-matched study","volume":"35","author":"Yang","year":"2016","journal-title":"Chin. J. Cancer"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1097\/SLA.0000000000004922","article-title":"Robotic-assisted Versus Video-assisted Thoracoscopic Lobectomy","volume":"275","author":"Jin","year":"2021","journal-title":"Ann. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"zrac050","DOI":"10.1093\/bjsopen\/zrac050","article-title":"Reasons for staying in hospital after video-assisted thoracoscopic surgery lobectomy","volume":"6","author":"Huang","year":"2022","journal-title":"BJS Open"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Haveman, M.E., Jonker, L.T., Hermens, H.J., Tabak, M., and de Vries, J.P. (2021). Effectiveness of current perioperative telemonitoring on postoperative outcome in patients undergoing major abdominal surgery: A systematic review of controlled trials. J. Telemed. Telecare., ahead of print.","DOI":"10.2139\/ssrn.3712941"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"596970","DOI":"10.3389\/fsurg.2020.596970","article-title":"Novel Pre- and Postoperative Care Using Telemedicine","volume":"7","author":"Geraci","year":"2020","journal-title":"Front. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1136\/bmjinnov-2019-000354","article-title":"Wearable devices for remote vital signs monitoring in the outpatient setting: An overview of the field","volume":"6","author":"Soon","year":"2020","journal-title":"BMJ Innov."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"S31","DOI":"10.4103\/sja.SJA_543_18","article-title":"The STROBE guidelines","volume":"13","author":"Cuschieri","year":"2019","journal-title":"Saudi J. Anaesth."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of Surgical Complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.jtcvs.2009.10.025","article-title":"Four-arm robotic lobectomy for the treatment of early-stage lung cancer","volume":"140","author":"Veronesi","year":"2010","journal-title":"J. Thorac. Cardiovasc Surg."},{"key":"ref_13","first-page":"288","article-title":"La telemedicina: Uno strumento di prossemica dell\u2019assistenza territoriale?","volume":"Volume 76","author":"Amato","year":"2020","journal-title":"Telemedicine: A Proxemics Tool of Primary Care?"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1913","DOI":"10.1002\/ijc.34202","article-title":"COVID -19 outcomes in children, adolescents and young adults with cancer","volume":"151","author":"Parker","year":"2022","journal-title":"Int. J. Cancer"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1053\/j.semtcvs.2021.03.038","article-title":"COVID-19 After Lung Resection in Northern Italy","volume":"34","author":"Scarci","year":"2022","journal-title":"Semin. Thorac. Cardiovasc. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"100324","DOI":"10.1016\/j.smhl.2022.100324","article-title":"Telemedicine: A cornerstone of healthcare assistance during the SARS-Cov2 pandemic outbreak but also a great opportunity for the near future","volume":"26","author":"Tartaglia","year":"2022","journal-title":"Smart Health"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Van Der Meij, E., Anema, J.R., Otten, R.H.J., Huirne, J.A.F., and Schaafsma, F.G. (2016). The Effect of Perioperative E-Health Interventions on the Postoperative Course: A Systematic Review of Randomised and Non-Randomised Controlled Trials. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0158612"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1177\/000313481908500847","article-title":"Using a mobile application for real-time collection of patient-reported outcomes in hepatopancreatobiliary surgery within an ERAS pathway","volume":"85","author":"Pickens","year":"2019","journal-title":"Am. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/j.ygyno.2018.06.007","article-title":"Use of a web-based app to improve postoperative outcomes for patients receiving gynecological oncology care: A randomized controlled feasibility trial","volume":"150","author":"Graetz","year":"2018","journal-title":"Gynecol. Oncol."},{"key":"ref_20","first-page":"425","article-title":"Process evaluation of a multidisciplinary care program for patients undergoing gynaecological surgery","volume":"24","author":"Bouwsma","year":"2013","journal-title":"J. Occup. Rehabil."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"5457","DOI":"10.1007\/s00464-017-5625-7","article-title":"Feasibility of real time location systems in monitoring recov-ery after major abdominal surgery","volume":"31","author":"Dorrell","year":"2017","journal-title":"Surg. Endosc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"133","DOI":"10.4103\/digm.digm_26_18","article-title":"An observational study to assess the feasibility of remote monitoring of patients in the early postoperative period after elective surgery","volume":"4","author":"Faiz","year":"2018","journal-title":"Digit. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s40814-019-0415-8","article-title":"Vital sign monitoring with continuous pulse oximetry and wire-less clinical notification after surgery (the VIGILANCE pilot study)\u2014A randomized controlled pilot trial","volume":"5","author":"Paul","year":"2019","journal-title":"Pilot Feasibility Stud."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.jamcollsurg.2017.12.013","article-title":"Feasibility of an image-based mobile health protocol for postoperative wound monitoring","volume":"226","author":"Gunter","year":"2018","journal-title":"J. Am. Coll. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1001\/jamasurg.2017.1519","article-title":"Wireless monitoring program of patient-centered outcomes and recov-ery before and after major abdominal cancer surgery","volume":"152","author":"Sun","year":"2017","journal-title":"JAMA Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"6512","DOI":"10.1245\/s10434-021-09707-3","article-title":"Post-discharge Telemonitoring of Physical Activity, Vital Signs, and Patient-Reported Symptoms in Older Patients Undergoing Cancer Surgery","volume":"28","author":"Jonker","year":"2021","journal-title":"Ann. Surg. Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"858242","DOI":"10.3389\/fonc.2022.858242","article-title":"Lung Cancer Treatment: From Tradition to Innovation","volume":"12","author":"Mangiameli","year":"2022","journal-title":"Front. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1016\/S0140-6736(20)30424-4","article-title":"Telemedicine 2020 and the next decade","volume":"395","author":"Dorsey","year":"2020","journal-title":"Lancet"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1136\/bmjopen-2017-017782","article-title":"Effectiveness of an internet-based perioperative care programme to enhance postoperative recovery in gynaecological patients: Cluster controlled trial with randomised steppedwedge implementation","volume":"8","author":"Bouwsma","year":"2018","journal-title":"BMJ Open"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1111\/1471-0528.12661","article-title":"A personalised eHealth programme reduces the duration until return to work after gynaecological surgery: Results of a multicentre randomised trial","volume":"121","author":"Noordegraaf","year":"2014","journal-title":"BJOG Int. J. Obstet. Gynaecol."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/15\/4\/1146\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:30:46Z","timestamp":1760121046000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/15\/4\/1146"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,10]]},"references-count":30,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["cancers15041146"],"URL":"https:\/\/doi.org\/10.3390\/cancers15041146","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,10]]}}}