Video-assisted Thoracoscopic Surgery (VATS) has become a mature thoracic surgery technique and one of the common clinical surgical methods after 15 years of continuous development; in many advanced medical centers in China and abroad, it has accounted for one-third or even more than half of the total number of thoracic surgical cases; its application The proportion also reflects the technical level of thoracic surgery in a hospital to a certain extent. The clinical application of TV thoracoscopy has changed the treatment concept of some thoracic diseases, especially in redefining the indications, contraindications and surgical approaches for certain diseases; at the same time, with the introduction of new technical means, new ideas and new methods, thoracoscopic technology itself has become more mature and rational. This paper briefly reviews the application of thoracoscopy in general thoracic surgery in recent years. First, the current situation of the application of thoracoscopy in the treatment of lung diseases The lung is the most used organ for thoracoscopic surgery, usually accounting for more than 70% of the total number of thoracoscopic procedures in the same period; it is also one of the most suitable sites for thoracoscopic surgery. 1, small intrapulmonary nodules and diffuse lung disease: with the popularity of clinical CT examination, the detection rate of peripheral type pulmonary nodules has increased. These pulmonary nodules, usually less than 3 cm in diameter (especially about 1 cm), may be early lung cancer, or benign lung tumors, or inflammatory masses in the lung; their common feature is that clinical diagnosis is very difficult. For such small nodules, the success rate of percutaneous lung puncture biopsy is low and there are many complications, and previously only open chest biopsy was available for pathological diagnosis. Many patients could not be diagnosed because of the fear of open-chest surgery, and even delayed the treatment of some early lung cancers. Television thoracoscopic surgery can accomplish the same lung wedge resection as open chest surgery with minimal trauma, which is very popular among patients and internists; therefore, the number of cases in which thoracic surgeons are exposed to and treat peripheral lung nodules has increased significantly in recent years. At the same time, thoracoscopy has an irreplaceable role in the diagnosis and differential diagnosis of diffuse lung lesions, such as interstitial fibrosis, pulmonary amyloidosis, idiopathic iron-containing hemoglobinopathy and diffuse alveolar cell carcinoma; it has significantly improved the diagnosis of these diseases. 2, emphysema and alveolar disease: Traditionally, the treatment of end-stage emphysema is mainly medical, but the efficacy is extremely limited, and the disease still progressively deteriorates. In the past, lung transplantation was the only means of surgical treatment, but it was difficult to promote because of many problems. In the last decade, lung volume reduction surgery (LVRS) has been reapplied to treat emphysema with satisfactory results, bringing hope for the treatment of emphysema. It is now believed that the ideal patient for surgery should meet the following three conditions: (i) a series of pathophysiological changes caused only by severe emphysema; (ii) a heterogeneous distribution of lesions, with severe lesions available for resection and located in the upper lobe of the lung; and (iii) hyperinflation of the lung. To date, the indications and contraindications for surgery remain relative; overall, only about 20-30% of patients screened for emphysema eventually meet the requirements and undergo lung volume reduction. The latter is performed under four 1CM incisions, with significantly less trauma, improved surgical safety, and comparable surgical efficacy. Therefore, thoracoscopic pulmonary decompression surgery is the best option when available. The indications for surgery for pulmonary alveolar disease include: (1) pulmonary alveoli causing dyspnea; (2) pulmonary alveoli larger than 1/2 of the volume of one side of the chest although the symptoms are mild; (3) pulmonary alveoli combined with more than 2 episodes of spontaneous pneumothorax; (4) although the first episode of pneumothorax but one of the following conditions, ① persistent air leakage, i.e., effective closed chest drainage > 72 hours still does not reopen the lung or still (2) spontaneous pneumothorax with bilateral or sequential attacks; (3) patients with special jobs, such as divers, pilots, field workers, etc., and patients in areas lacking basic medical care; for athletes and university and high school students, the indications for surgery can also be appropriately prevented; (4) spontaneous hemopneumothorax; (5) spontaneous tension pneumothorax. Thoracoscopic alveolar resection is usually very easy, but when the alveoli are huge, or the pleural adhesions are serious, or when the alveoli are all over the surface of the lung, it is very difficult to deal with them, and sometimes it is necessary to transfer to small incision open-heart surgery. 3.Lung cancer: In terms of diagnosis, thoracoscopy can easily solve the problem of difficult diagnosis of early peripheral type small lung cancer and the problem of differential diagnosis of cancerous pleural fluid caused by lung cancer. In terms of treatment, lung wedge resection can be used as a palliative treatment for T1N0M0 lung cancer patients of advanced age and whose lung function cannot tolerate open-heart surgery; lobectomy is technically mature and is currently mainly used for the treatment of stage IA (T1N0M0) non-small cell lung cancer and metastatic cancer that requires lobectomy; thoracoscopic talc pleural fixation can successfully eliminate more than 95% of Thoracoscopic talc pleural fixation can successfully eliminate more than 95% of intractable malignant pleural fluid caused by lung cancer. In terms of lung cancer staging, thoracoscopy can understand whether there is invasion or metastasis of the pleura (T stage), and can also explore the tumor site, size, invasion and metastasis in the lung (T and M stage), and at the same time, it can also perform ipsilateral mediastinal lymphatic group biopsy (left side: 5-10 groups; right side: 2-4 and 7-10 groups); however, compared with mediastinoscopy, it requires double-lumen tube cannulation and cannot perform contralateral lymph node biopsy at the same time. Complications are relatively high; therefore, it is only selectively used for staging lung cancer and cannot replace mediastinoscopy yet. The application of thoracoscopy in the diagnosis and treatment of esophageal diseases 1. Esophageal smooth muscle tumor: the traditional removal of esophageal smooth muscle tumor is performed through posterior lateral thoracotomy, which is a typical “small surgery with large incision”. The application of thoracoscopic surgery has changed the surgical pathway of esophageal smooth muscle tumor, and the removal of esophageal smooth muscle tumor can be completed under 3-4 1cm trocar incisions. The operation time is short, and it is less traumatic, less painful and faster recovery. 2, cardia achalasia: so far, esophageal myotomy is still the most effective and standard procedure for the treatment of cardia achalasia. At present, thoracoscopic or laparoscopic esophageal myotomy has basically replaced the conventional open-heart surgery. 3.Esophageal cancer: Thoracoscopy provides a third treatment method for esophageal cancer resection other than open thoracotomy and non-open esophageal dissection (EWT). The surgery generally consists of three parts, first, thoracoscopic freeing of the thoracic segment of esophagus; second, open freeing of the stomach; and third, neck incision for end-lateral esophagogastric neck anastomosis. The resection of the thoracic esophagus is done under four 1CM incisions, which is less traumatic, safe and reliable, and the operation time is short (usually about 1 hour), in line with the development of esophageal surgery. At present, individual doctors in China propose the so-called “hand-assisted esophageal cancer resection method”, in which the esophagus and tumor are peeled off from the abdominal cavity through the diaphragm with one hand in the chest cavity. However, it is not a standardized thoracoscopic esophageal cancer resection surgery in the real sense, and more importantly, it does not conform to the principle of tumor surgery (tumor-free operation), and there is a possibility that the cancer cells may be planted into the abdominal cavity with the operator’s hand. This esophageal free method is still inferior to the small incision (5-8CM) surgery assisted by thoracoscopy from both the perspective of minimally invasive and oncological surgery principles, which is a very questionable method. The current status of thoracoscopic application in the treatment of mediastinal diseases 1. myasthenia gravis: thymectomy is one of the most effective methods for the treatment of myasthenia gravis (Myasthenia Gravis: MG). Thoracoscopic thymectomy requires only three 1.5 cm chest wall incisions, which can clearly reveal the thymus and the entire anterior mediastinum, and can simultaneously perform thyme and anterior mediastinal fat resection, and the resection range is basically the same as that of median sternotomy; in recent years, several clinical reports from domestic and foreign groups have shown that its long-term efficacy is not different from other methods, and it is a new and more ideal route for thymus surgery. 2.Mediastinal tumor: posterior mediastinal neurogenic tumor is one of the most suitable diseases for thoracoscopic surgery. However, malignant tumors or when the tumor often extends into the interporeal foramen or even invades the intradural space, thoracoscopic surgery should be disabled or used with caution. Mediastinal cysts, including bronchial cysts, pericardial cysts, and enterogenic cysts, are among the common benign diseases of the mediastinum and are the most suitable conditions for thoracoscopic surgery. Thoracoscopy can easily remove mediastinal cysts of various sizes. Some thymomas, especially those less than 5 cm in diameter without external invasion, are suitable for thoracoscopic removal along with the entire thymus. Some benign mediastinal teratomas can also be removed thoracoscopically. 3.Other: thoracoscopic thoracic sympathectomy for hand sweating, head sweating, long QT syndrome and other diseases is less traumatic and reliable, and has become a routine clinical procedure. It can also treat a variety of neurovascular lesions and be used for pain relief of advanced cancer (such as pancreatic head cancer), etc. Celiac disease due to various causes can be treated by thoracoscopic surgery as long as there is no contraindication to surgery; thoracoscopic ligation of the thoracic duct combined with pleural fixation can effectively treat celiac disease.