In recent years with the improvement of surgical equipment conditions and operation techniques, thoracoscopic surgery has been widely used in the surgical treatment of thoracic surgical diseases. The mediastinum, with its complex structure and multifunctional cells, is the most complex area in the human body in terms of the types of tumors that occur, and contains a group of lesions of varying shapes, sizes, and natures. The most common mediastinal tumors are thymomas, neurogenic tumors, primary cysts, lymphomas, and germ cell tumors, most of which are benign. In principle, mediastinal tumors should be treated surgically upon diagnosis. However, traditional surgical methods cause great damage to chest muscles and sternum, with many complications, obvious postoperative pain and slow recovery, which are difficult to be accepted by patients. In recent years, with the application of modern thoracoscopic surgery, a new way for the treatment of mediastinal tumor has been opened up. Compared with other thoracic and cardiac surgery, mediastinal tumor resection is a “destructive” surgery, which does not require “reconstruction” or “repair”, and is therefore more suitable for thoracoscopic operation. According to the treatment experience of this group of cases, we know that thoracoscopic surgery for mediastinal tumors has the following advantages: (1) less trauma, less pain, faster recovery, and in line with the requirements of cosmetic; (2) the surgical field is clear, magnifies the microstructure, and can safely deal with the relationship with the important structures, and the field of vision involves all parts of the mediastinum, with virtually no dead space; (3) it can be sampled from multiple points, and the specimen is large enough for routine examination, histochemistry and electron microscopy scanning to determine the nature of the tumor, and to guide the treatment of the tumor. The specimen is large enough for routine pathological examination, histochemical examination and electron microscopy to determine the nature of the tumor and guide chemotherapy; ④ Mediastinal tumor resection can be performed without or with fewer disposable consumables, and the length of hospital stay is significantly shorter than that of traditional surgery, which significantly reduces the overall cost. The average postoperative hospitalization time of this group was 5.5 d. All patients recovered well after the operation without obvious complications, and achieved a more satisfactory therapeutic effect. Although thoracoscopic surgery has the above advantages, it can not completely replace the traditional surgical methods. The indications for surgery should be strictly controlled, and we routinely take chest X-ray and chest CT enhancement scan before surgery, which can clarify the nature of the tumor, location, size, whether the envelope is intact, whether there is outward infiltration and the relationship with the surrounding organs, and determine the degree of difficulty of thoracoscopic surgery. Preoperative surgery should also determine whether to perform thoracoscopic surgery by judging the benignity or malignancy of the tumor. Malignant or invasive tumors usually require open-heart surgery, but thoracoscopy can be used for intraoperative exploration or biopsy. Preoperative CT and MRI examination is especially important for neurogenic tumors. If the tumor is found to grow into the spinal canal through the intervertebral foramen, it is easy to injure the nerve root or spinal cord when separating the tumor, and it is difficult to remove the intradural portion of the tumor, which should be regarded as contraindication to thoracoscopic surgery, and the spinal surgeon should be invited to complete the surgery together if necessary. The size of the tumor and the presence or absence of thymoma with myasthenia gravis are not necessary bases for choosing thoracoscopic surgery. For larger cystic tumors, we achieved the goal of improving the surgical field, facilitating the operation, and preventing extravasation of cystic fluid through intraoperative volume reduction, and for tumors that were difficult to remove, the operation was successfully completed by improving the specimen removal technique or appropriately lengthening the surgical hole. At present, it is generally believed that giant mediastinal tumors are not suitable for thoracoscopic surgery, and mediastinal tumors with diameters greater than 10 cm are usually discussed as giant tumors in clinical practice. Due to the huge tumor, there are often compression and invasion of surrounding organs, heavy adhesion between the tumor and blood vessels, etc., and it is easy to damage blood vessels during the operation and cause adverse consequences. Such patients should be treated with safety as the first priority, and they should be resected by conventional open thoracotomy. For thymoma combined with myasthenia gravis, it has been proved to be feasible to perform total thymectomy and mediastinal fat sweeping under thoracoscopy, and the results reported in the literature are similar to those of the median open thoracotomy 5 patients with myasthenia gravis were followed up in our department or neurology department for 1~16 months, with the symptoms completely relieved or significantly improved, and the efficacy of the treatment was satisfactory. Intraoperative bleeding used to be a major threat in thoracoscopic surgery, but with experience, this problem has been better addressed. If large bleeding is caused inadvertently, maintaining a clear vision is the key, and then try to control it with hemostatic forceps and titanium clips to turn “large bleeding into small bleeding”, try to avoid changing “large bleeding into large bleeding”, and then completely stop the bleeding by sewing or tying as appropriate. If it is difficult to control microscopically, it should not be forced, and should increase the number of small incisions or directly transfer to open chest to ensure safety. In conclusion, thoracoscopic surgery provides a safe and effective choice for the diagnosis and treatment of mediastinal tumors, but as a surgical pathway, it is still necessary to follow the diagnostic and therapeutic principles of surgical oncology, strictly master the indications and contraindications, continuously improve the surgical skills, and pay close attention to the long-term efficacy, so as to enable it to play its due role in the diagnosis and treatment of mediastinal tumors.