OBJECTIVE: To investigate the safety, feasibility and effectiveness of total thoracoscopic lobectomy in the treatment of bronchiectasis. METHODS: The clinical data of 24 cases of total thoracoscopic lobectomy for bronchiectasis completed in our center from April 2007 to November 2009 were retrospectively analyzed. Total thoracoscopic anatomical lobectomy was performed without distraction of the ribs, and the pulmonary vessels and bronchi were treated separately with cutting sutures. In case of severe adhesions or bleeding, etc., the operation was intermediate to open thoracotomy. The operative time, bleeding volume, postoperative time with tube, and complications were recorded. RESULTS: Two cases (8.3%) in the whole group were referred to open thoracic surgery with VATS-assisted small incision because of heavy intrathoracic adhesions, poor differentiation of interlobular fissures or severe adhesions at the hilum with a large number of tortuous dilated vessels, which were difficult to handle microscopically. The remaining 22 cases were completed under full thoracoscopy. The extent of lung resection included one case of right upper lobe, one case of right middle lobe, three cases of right lower lobe, two cases of left upper lobe, 13 cases of left lower lobe, one case of left lower lobe + left upper lobe lingual segment, and one case of left lower lobe + right middle lobe resection. The operative time was (173.6±57.1) min (80~280 min), the bleeding volume was (173.9±65.9) ml (50~300 ml), the postoperative tube time was (6.1±3.8) d (2~19 d), and the postoperative hospital stay was (8.6±3.9) d (4~22 d). All postoperative pathologies were consistent with bronchiectasis changes. There were no perioperative deaths. Four cases of complications, all with persistent pulmonary air leak >7 d, were drained for 7-19 d and the chest drainage tube was removed spontaneously. The whole group was followed up for 1 to 31 months, with an average of 13.7 months, of which 13 cases were >12 months. 15 cases (62.5%) had complete disappearance of cough or hemoptysis after surgery, 7 cases (29.2%) had significant reduction in sputum volume, but still had intermittent symptoms such as cough or hemoptysis. 2 cases (8.3%) had no significant change in the amount of hemoptysis or sputum volume compared with before. Conclusion: Total thoracoscopic lobectomy is a safe and effective method for the treatment of bronchiectasis.