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This article describes the techniques for performing a video-assisted thoracic surgery (VATS) lobectomy. Each lobe can be approached from anteriorly, posteriorly, or intralobarly. Each method is described and the advantages of each technique are discussed. The surgical results in 105 cases are presented. The VATS technique has decreased operative trauma and has shortened hospital stay with a concomitant reduction in cost to the patient and health-care provider. These advantages make VATS lobectomy an excellent alternative for excision of well localized peripheral lung cancer.

The indications for thoracoscopy are undiagnosed pleural disease effusions of tumors; when tissue specificity is important for future treatment and adequate tissue is needed for estrogen binding studies; undiagnosed pleuropulmonary disease; biopsy of pulmonary lesions undiagnosed by other means; mediastinal masses, particularly in children; hilar masses; preoperative screening preliminary to thoracotomy for resection in malignant disease, particularly those with effusions; in spontaneous pneumothorax, to define the abnormality and indicate the need for thoracotomy; for postresection space problems; trauma, and, of course, for intrapleural pneumonolysis.