Surgery is still the only way to cure lung cancer, but the traditional method of lung cancer treatment requires a 30 cm long incision in the skin of the chest, cutting through the muscles of the chest wall, cutting through the muscles between the two ribs, propping up the ribs to make the incision 10-15 cm wide, and sometimes breaking one or two ribs. Only in this way can the surgical area be fully exposed so that the diseased lung lobe can be removed. Traditional dissection of the chest is very traumatic, and it takes about two weeks to be discharged from the hospital after surgery, and some patients lose the opportunity to have surgery because their physical condition cannot withstand the trauma of surgery. Post-operative incision pain is also an important problem for patients. In fact, it is the width of the intraoperative rib support that is the main factor causing post-operative pain. Previous surgeries required direct visualization of the lesion in order to complete the surgery, which required the incision to be widened, otherwise it would not be clearly visible even if the incision was long, i.e., no matter how small the incision was, as long as the operation was performed under direct vision, it was inevitable that the ribs would be propped up and the incision widened. Thoracoscopic surgery is a new minimally invasive thoracic surgery technique that uses modern camera technology and high-tech surgical instruments and equipment to complete complex surgery in the chest wall under a trocar or tiny incision. Complete thoracoscopic surgery requires only one to three small 1.5 cm holes in the chest wall, and a tiny medical camera projects the situation inside the chest cavity onto a large display screen, which is equivalent to putting the surgeon’s eyes into the patient’s chest cavity for surgery. The surgical field of view can be enlarged as needed to show subtle structures that are clearer and more flexible than under direct visualization by the naked eye. Therefore, the exposure of the surgical field, the appearance of the subtle structures of the lesion, the judgment of the scope of surgical resection and the safety are better than those of ordinary open-heart surgery. Thoracoscopic lobectomy for lung cancer requires only three incisions in the chest, which are about 1.5 cm long. Not only is the incision length significantly shorter than that of previous surgeries, but more crucially, it does not require the opening of the rib cage, avoiding the trauma caused by opening the rib cage. Unlike traditional surgery, the surgeon does not perform the operation under direct visualization. During surgery, a 1 cm diameter tubular endoscope is placed into the chest through one incision, and an external fiber optic cable transmits the intra-thoracic situation to the TV monitor, while two other incisions are made to place special long-handled instruments of 0.5 to 1 cm diameter. The operator looks at the TV and does not need to enter the chest, but operates these long-handled special instruments outside the chest cavity to complete the radical lung cancer surgery. With the accumulation of experience in thoracoscopic operation, there has been a gradual transition from the original 3-4 holes to two holes, or even a single hole. The advantages of thoracoscopic lobectomy are: ①Low surgical trauma: ordinary open-chest surgery is very traumatic, with incisions above 500px, serious chest wall damage, severing all layers of chest wall muscles, and also forcibly propping open the intercostal area by 10-500px, and postoperative pain has been difficult to resolve. In contrast, thoracoscopic surgery can be completed by making three small 37.5px long incisions in the chest wall, and there is no need to open the intercostal space, which greatly reduces the trauma of surgery. ②Light postoperative pain: Common open-heart surgery has a large trauma to the chest wall and forceful intercostal opening during surgery, resulting in significant postoperative pain, which can last for months to years, and most patients have limited activities after surgery. Thoracoscopic surgery is not necessary to open the intercostal space, so the patient’s pain is significantly reduced after surgery, and he can get out of bed on the day of surgery and resume normal work 2-4 weeks after surgery. ③Low impact on pulmonary function: Since thoracoscopic surgery does not cut off the chest wall muscles and does not open the ribs, the integrity of the thorax and the patient’s respiratory function are largely preserved compared with conventional open-heart surgery, so the patient’s postoperative pulmonary function and mobility are better than those of patients undergoing conventional open-heart surgery. ④Small impact on immune function: surgery will reduce the immune function of the body to different degrees, and the greater the surgical trauma, the greater the impact on immune function, compared with conventional open thoracotomy, thoracoscopy significantly reduces surgical trauma and greatly reduces the impact on immune function. ⑤ Less postoperative complications. ⑥Smaller postoperative scars and more aesthetic appearance. Despite all the advantages of thoracoscopic surgery, patients may still have concerns about this new surgical modality. In fact, there are two main concerns for patients: treatment effect and treatment cost. Is thoracoscopic surgery a complete treatment for lung cancer? This was a central topic of debate in thoracic surgery and oncology worldwide more than a decade ago. In a review of thousands of cases from 21 centers, thoracoscopic lobectomy can completely clear all lymph nodes in the chest cavity as well as traditional open surgery, and has shown significantly better five-year survival rates than traditional open surgery. As early as 2006, the National Comprehensive Cancer Network (NCCN) guidelines for the treatment of lung cancer clearly stated that “thoracoscopic lobectomy is a viable option for resectable lung cancer,” which means that the indications for total thoracoscopic lobectomy have been internationally recognized. In fact, the effectiveness of thoracoscopic lobectomy in the treatment of lung cancer depends on two main points: ① The operating technique of the operator. This type of surgery requires the operator to have rich experience in thoracoscopic surgery and at the same time to have done a large number of traditional open lobectomies and be familiar with the anatomy in the chest cavity. ② Selection of patients for surgery. Of course, not all lung cancer patients are suitable for thoracoscopic surgery. Generally speaking, patients with no obvious invasion of surrounding organs and no obvious mediastinal lymph node enlargement can undergo thoracoscopic lobectomy along with systematic mediastinal lymph node dissection. Based on our surgical experience, the thoracoscopic operation is actually clearer and easier than the open-chest direct view operation, and the bleeding is only one-fifth of that of the traditional operation. Patients are usually able to get out of bed in a day or two after surgery and are discharged from the hospital in about a week. Our practice is still relatively conservative, with some medical centers discharging patients 3 days after lumpectomy for lobectomy or segmental lung resection.