Minimally invasive surgery is a growing trend in surgery, and more and more new concepts in minimally invasive surgery are being proposed. The new concept of “TubelessVATS” was the focus of discussion in this conference. In this interview, Prof. Cai Kaichan of Nanfang Hospital introduced three aspects of the “TubelessVATS” concept: “no tracheal intubation during anesthesia; no chest tube after surgery; no urinary catheter during the perioperative period”. Prof. Cai believes that this concept brings many benefits to patients, “For example, no chest tube during VATS surgery, postoperative patients have the advantages of less pain, less trauma, getting out of bed earlier, and shorter hospitalization time. The concept of “Rapid Rehabilitation Surgery” is to eliminate chest tubes as much as possible, and to remove tubes as early as possible. Despite all the advantages, the key is to see if it can be done.” That’s exactly the point of this discussion session. In order to discuss the non-retention of chest tube after open chest or VATS, Prof. Cai further elaborated on the following three aspects: i. Why retain a chest tube? The purpose of indwelling chest tube after surgery is to drain postoperative bleeding, exudate and air leakage, restore negative pressure in the pleural cavity, and promote lung reopening; 2. It is convenient to observe postoperative bleeding, exudate and air leakage in the pleural cavity, and formulate a treatment plan according to the nature and amount of drainage fluid; 3. After the anesthesiologists carry out positive-pressure ventilation to expand the lungs at the end of the surgery and turn the patient around, due to various reasons, it may be impossible to completely drain the air from the pleural cavity, and a certain degree of residual air in the pleural cavity will be present after surgery. After surgery, there will be a certain degree of residual air in the pleural cavity, which needs to be drained through the chest tube after surgery; 4. After surgery, the presence of negative pressure in the pleural cavity may cause bleeding, seepage or air leakage, which also needs to be drained through the chest tube. Why don’t we keep chest tube? 1, has been concluded that: ① total thoracoscopic surgery for lung diseases without chest tube for patients after surgery, with less pain, less trauma, get out of bed earlier, shorter hospital stay, etc.; ② single operation hole can reduce the incidence of intraoperative chest wall hemorrhage, postoperative pain and sensory-motor abnormalities and other complications, coupled with the absence of a chest tube, postoperative pain is significantly reduced; 2, the chest tube to the postoperative pain of the probable cause: ① intercostal The lateral cutaneous branch of the intercostal nerve emanates near the anterior axillary line, and now the chest tube is mostly inserted between the anterior axillary line and the mid-axillary line, which compresses the intercostal nerve (the second rib from the mid-clavicular line is rarely painful, and the closure of the intercostal nerve can help to alleviate the pain); ② the chest tube is inserted into the thoracic cavity for too long or twisted, which stimulates the diaphragm or the wall layer of the pleural membrane; ③ the chest tube is made of a harder material or the tube is thicker in diameter; ④ psychological factors, mental stress, excessive attention; III. Can the chest tube be left in? In order to reduce the patient’s pain, the doctor thought about the possibility of not placing a chest tube. Prof. Cai said that as long as there is no postoperative bleeding and air leakage, it is theoretically feasible not to put in chest tube after thoracic surgery, especially the less traumatic VATS surgery; 2. Alternative measures for those who can not directly observe the intrapleural hemorrhage, nocturnal bleeding, and pneumoperitoneum after the surgery: observe the patient’s respiratory rate, depth, and respiratory tone with or without any abnormality; monitor the blood pressure, heart rate, and oxygen saturation level; and observe pleural space accumulation dynamically on a regular basis through chest radiographs and bedside ultrasound; 3. B ultrasound dynamic observation of pleural cavity pneumoperitoneum, fluid accumulation. 3, in the actual clinical work, for some small VATS after surgery, has long been realized without chest tube, and get satisfactory results. “For example, in hyperhidrosis, funnel chest NUSS surgery, and some mediastinal tumor surgeries, we routinely do not install chest tubes, and adequate exhaustion at the end of the operation is sufficient. So what other surgeries can be performed without a chest tube? We believe that the following cases can also be considered: ① for the first attack of spontaneous pneumothorax patients, pulmonary blisters are located in the apical part of the lungs, the distribution is more concentrated; ② lung nodule patients, no obvious discomfort complaints before the operation, found by physical examination chest radiograph or chest CT, and independence of small pulmonary nodules; ③ mediastinum, pleura, esophagus and other small benign single lesions. The “TubelessVATS” technology means a new breakthrough in minimally invasive thoracic surgery in terms of rapid rehabilitation, but as a new technology and concept, it needs to be confirmed by further large sample studies. Mr. Cai also shared his opinion in this regard: “Currently, no chest tube is only suitable for small and simple surgeries, but in the future, we may extend it to more complicated surgeries, and there is such a possibility. First of all, with the gradual improvement and refinement of many surgical instruments for VATS, there is little or no bleeding and air leakage after cutting and closing, so there is no need to keep a chest tube because the purpose of the chest tube is to ventilate and drain fluids after surgery. There is also the case of major surgery, large surgical wounds or preoperative neoadjuvant therapy, postoperative leakage and bleeding, in addition to the problem of oozing, if it is estimated that there is a greater likelihood of postoperative oozing, it is recommended that the chest tube should be left in place, which will be safer. In conclusion, cases need to be carefully selected intraoperatively, and should not blindly expand the indications and reluctantly do so.” Finally, talking about the part of the conference that impressed him the most, Prof. Cai said that the naked eye 3D technology impressed him the most. Prof. Cai introduced that his hospital, the Southern Hospital, has three 3D thoracoscopic surgical equipment and has already carried out this surgery with satisfactory results. Prof. Cai also compared the traditional 3D and naked eye 3D thoracoscopic technology and put forward their respective limitations, “Now our hospitals carry out 3D also need to wear glasses, a long time of surgery will bring eye fatigue and inconvenience to the operator and assistants, if you can not wear glasses and can achieve the effect of 3D, that is of course very good, but also a remarkable technological innovation. Today, we have experienced the 3D effect at the venue, and if we adjust the right distance, the 3D effect is quite good, no less than the traditional 3D effect. These results should be attributed to the team of Prof. He Jianxing and SuperD’s joint research and development and hard work. However, there are some limitations of naked eye 3D, if the display is 26 inches, the operator is required to distance from the display of about 1.5-2 meters, if the distance beyond this effect is not good; when the main knife in the appropriate angle, the assistant in another angle, the effect of naked eye 3D is not necessarily very good; there is also the display of the lag time, etc. I think that with the continuous maturation of the naked eye 3D technology, these limitations will be gradually resolved and improved, I believe that the naked eye 3D effect is very good. I think that as the naked eye 3D technology continues to mature, these limitations will gradually be solved and improved, I believe that naked eye 3D will have a bright future, it is worthwhile to look forward to together. In addition, during the conference, the release of the Chinese and English editions of LungCancer, edited by He Jianxing and Zhi Xiuyi, added a new highlight to the forum. The book, which was jointly completed by internationally renowned scholars and clinicians, covers the basic science of lung cancer to the state-of-the-art treatments, providing readers, whether they are students or specialists, with all-around guidelines on lung cancer.