There are many tissues and organs in the mediastinum, and a variety of tumors can occur, even if the tumor is small in size, it can cause circulatory, respiratory, digestive and neurological dysfunction. Therefore, how to reduce the surgical trauma, relieve the patient’s pain and speed up the recovery time has become the primary problem faced by thoracic surgeons. Although the traditional open-heart surgery has a clear view, the surgery is more traumatic, the wound is unsightly, the patient has obvious pain, the postoperative recovery time is longer, and there are more complications. However, TV thoracoscopic mediastinal tumor resection has compensated for these disadvantages and is becoming more and more common in the treatment of mediastinal tumors. Compared with traditional open-heart surgery, this method has the characteristics of minimally invasive, aesthetic wound, less physiological interference, and can preserve the pectoral muscle without damaging the intercostal nerve cortex, so the pain is less, bleeding is less, and the postoperative recovery is faster. Thymoma is the most common type of mediastinal tumor, followed by neurogenic tumors. According to the anatomical location of the mediastinum, it can be divided into 3 parts: anterior, middle and posterior, and different incisions should be chosen for different parts of the tumor. However, in the clinical process, we should not just emphasize the application of minimally invasive surgery, but also choose the appropriate surgical approach according to the specific location and type of tumor as well as the specific situation of the patient. For example, in patients with large thymoma combined with myasthenia gravis, although the main body of thymus is located in the chest, the ectopic or vagal thymus is widely distributed in mediastinal fat and even neck fat, so all tissues such as thymus and fat in the anterior mediastinum need to be completely removed to achieve the best effect. In addition, preoperative CT examination is crucial to the choice of surgical site and surgical plan. CT can clearly reflect the connection between the mass and the surrounding tissues and organs, and make preliminary analysis of the nature of the tumor in order to assess the ease of surgery and determine the surgical site and plan.