OBJECTIVE: The method and efficacy of lung tumor surgery with small incisions assisted by television thoracoscopy. RESULTS: A total of 118 cases of lung cancer were admitted to our department in (2003.02-2008.11). The operating time was 65-195 min, with an average of 90 min, intraoperative bleeding was 120 ml on average, postoperative drainage was 150-320 ml, with an average of 180 ml, and the chest drains were removed 48-72 hours after surgery, and no postoperative complications such as pulmonary atelectasis occurred. The duration of hospitalization was 10-15 days, with an average of 11.3 days. CONCLUSION: The procedure can also achieve the advantages of less trauma, less intraoperative bleeding, faster postoperative recovery and shorter hospital stay. It is worth promoting in the clinic. 1. Clinical data 1.1 General data: 118 cases of lung cancer were admitted to our department in (2003.02-2008.11), which were all peripheral type lung cancer with tumor diameter between 2-5 cm, including 28 cases of left upper lung cancer, 26 cases of left lower lung, 37 cases of right upper lung, and 27 cases of right lower lung. TMN stage: 3 cases of stage Ia Ⅰb 25 cases, Ⅱa 43 cases, and Ⅱb 47 cases. Mediastinal lymph node clearance was performed intraoperatively, and 75 cases were found to have mediastinal lymph node metastasis by pathological examination. All patients had no tumor residue in the tracheal resection margin. 1.2 Surgical method: General anesthesia with double-lumen tracheal intubation, left or right lateral recumbency, slightly padded chest and fixed on both sides. First, a 1.5 cm incision was made in the seventh intercostal area in the mid-axillary line, at this time, single-lumen ventilation was performed, and the poke card was inserted into the chest cavity to understand the specific location and size of the tumor and whether the chest cavity was adherent or effusion. A 6-8 cm long incision is made from the mid-axillary line to the anterior axillary line in the fifth intercostal space, and the lung fissure and hilar are dissected with the assistance of thoracoscope. The veins and arteries of the pulmonary lobes were separated and freed from each branch, and the vessels were double ligated and cut with a deep knotter, at which time the hilum was freed clearly. The diseased lung was removed with a bronchial closure device and the bronchial stump was closed, the diseased lung was removed, and the hilar and mediastinal lymph nodes were cleared. 1.3 Results All cases in this group were operated with the assistance of thoracoscopy, and the operation time was 65-195 min, with an average of 90 min. The average intraoperative bleeding was 120 ml, and the average postoperative drainage was 150-320 ml, with an average of 180 ml. There were no postoperative complications such as pulmonary atelectasis. The duration of hospitalization was 10-15 days, with an average of 11.3 days. All had good quality of life at 6-12 months of follow-up. 2.Discussion At present, minimally invasive surgery has been steadily developed in various surgical fields, and the technology has become increasingly mature, and various new procedures and techniques are emerging. Some hospitals have performed purely thoracoscopic radical lung cancer resection, but the cost of using disposable instruments during surgery is high and most patients cannot afford it, so it is difficult to be promoted. By adopting TV thoracoscopy-assisted small incision for surgery, the operation can also achieve the advantages of less trauma, less intraoperative bleeding, faster postoperative recovery and shorter hospitalization time. Traditional open-chest surgery is traumatic, bleeding and unfavorable to recovery. Compared with a small incision in the chest alone, the operation is flexible and convenient due to improved operative field illumination and wider field of view by thoracoscopy. It is a promising minimally invasive surgical technique. In case of senior patients, poor cardiopulmonary function cannot tolerate unilateral lung ventilation, or serious adhesions between tumor and pleura, especially dense chest separation has some difficulties, so it is not suitable to choose small incision surgical method, and traditional open chest surgery should be chosen. It is very important to choose double-lumen tracheal intubation to ensure single-lumen ventilation, because single-lumen ventilation on the affected side can be completely collapsed to facilitate full exposure and operation of the surgical field. The incision was chosen in the anterior axillary line between 4 or 5 ribs near the pulmonary hilum for easier operation. The viewing scope is more suitable at the seventh intercostal space in the mid-axillary line, as either too high or too low will affect the intrathoracic operation. As small incision assisted by the use of traditional surgical instruments and endoscopic instruments can be used in combination, it is relatively easier to operate than pure thoracoscopic instruments. However, the operator must be skilled in the use of deep instruments and knot tying techniques. In thoracoscopically assisted small incision lung cancer resection, the operator’s hand cannot go into the chest cavity completely to perform the operation because of the narrow chest incision. Therefore, it is necessary to use mirror and light source illumination to thoroughly check hemostasis and prevent excessive postoperative drainage during the operation. The operation tries to achieve complete resection of the tumor as much as possible. If it is found by exploration that a small incision may not achieve complete resection. Then it will be changed to conventional open-chest surgery, which cannot only pursue small incision and affect the effect of tumor treatment. Thoracoscopic dissection, free vessels and lung lesions should be done with special care and reliable vascular ligation. Therefore, proficiency in deep knot tying is very important, and the bronchial stump should preferably be encapsulated with surrounding tissues to prevent bronchial fistula.