Minimally invasive surgery is the current trend of surgical development, which is represented by the application of endoscopic technology in various subspecialties, and the following describes the development of minimally invasive surgery in the field of thoracic surgery. Started in the early nineties, TV thoracoscopic surgery is a thoracoscopic surgery equipped with modern TV camera technology and high-tech surgical instruments. It has become a representative surgery of minimally invasive thoracic surgery and is one of the major advances in thoracic surgery at the end of the twentieth century. It has changed the concept of treatment of some thoracic diseases and is considered to be another major technical revolution in the field of thoracic surgery since the introduction of extracorporeal circulation and is the future direction of thoracic surgery. TV thoracoscopic surgery has the advantages of small trauma, light pain, reliable efficacy, and incision in line with cosmetic requirements, and the application scope has involved all fields of thoracic surgery. In the field of emphysema surgery, unilateral or bilateral lung decompression surgery via thoracoscopy has become one of the common surgical paths for lung decompression with less trauma, faster recovery, and less postoperative complications and mortality than patients in the median open-heart group. In addition, thoracoscopic assisted coronary artery bypass grafting has been mastered and applied by more and more cardiac surgeons; there are also many successful reports of thoracoscopic treatment of simple precardiac surgery and heart valve replacement. In 1992, the Department of Thoracic Surgery of the First Hospital of Beijing Medical University successfully carried out televised thoracoscopic surgery in China. In the past 8 years, they have been diligent and aggressive, and have maintained a leading position in China in terms of the number of surgical cases, especially the type of surgery and the difficulty of surgery, creating the vast majority of firsts in the type of TV thoracoscopic surgery in China. In order to promote the popularization and development of TV thoracoscopic surgery in China, the first national symposium on thoracoscopic surgery was successfully held at the First Hospital of Beijing Medical University in June 1994, and a training course for thoracoscopic surgeons was also held to train the first batch of qualified thoracoscopic surgeons from all over China. This meeting had a profound impact on the development of thoracoscopic surgery in China. Since then, three national thoracoscopic surgery symposiums were held in 1995, 1996 and 1998 respectively, and the National Thoracoscopic Surgery Collaborative Group was established in 1995, which was changed into the Thoracoscopic Surgery Group of the Thoracic and Cardiovascular Surgery Branch of the Chinese Medical Association in 1998. This is of great significance to promote the development of TV thoracoscopic surgery and standardize the surgical methods in China. However, due to the lack of awareness and conditions, the development of TV thoracoscopic surgery in China is still very unbalanced, and the popularity is much lower than that of developed countries. At present, only a few hospitals in China have reached or approached the advanced foreign level in the application of surgery, mainly in general thoracic surgery; however, the proportion of our hospitals and doctors who can perform TV thoracoscopic surgery is still very small and limited to the central cities and economically developed areas. A considerable part of thoracic surgeons do not know enough about TV thoracoscopic surgery and lack the necessary knowledge of TV thoracoscopic surgery, and most patients who can be treated by TV thoracoscopic surgery are not able to enjoy this minimally invasive surgery. The clinical application of any new technology must first determine its scope of application, i.e. the indications for surgery. Indications for TV thoracoscopic surgery include: 1. Diagnostic surgery indications: thoracoscopic exploration can be used for the diagnosis of a variety of chest diseases including pleural, pulmonary, mediastinal and pericardial diseases as well as thoracic trauma; it can clearly display the lesions in the chest cavity on the TV. The operator can not only judge the nature of the lesion by direct vision, but also basically obtain satisfactory tissue specimens for pathological examination. 2, therapeutic surgical indications: the biggest difference between TV thoracoscopy and traditional thoracoscopy is that it not only significantly improves the accuracy and application of thoracoscopic diagnosis, but also is more often used for surgical treatment of chest diseases, the latter being the most important feature of TV thoracoscopic surgery. At present, it is mainly used in the following areas: (1) pleural diseases: pleural lesions are the most suitable thoracic surgical diseases for diagnosis and treatment via thoracoscopy, including pleural cavity infection pus, pleural mesothelioma, metastases, trauma and fluid, pneumothorax, etc. (2) Lung diseases: including lung biopsy, resection of benign lung masses, partial lung cancer surgery, and lung decompression surgery, which is currently one of the most effective methods for treating end-stage emphysema. (3) Esophageal diseases: including esophageal smooth muscle tumor, esophageal diverticulum, cardia incontinentia, and esophageal cancer. (4) Mediastinal diseases: Generally, mediastinal tumors less than 5 cm in diameter can be tried for thoracoscopic surgery. (5) Others: including hand sweating, celiac disease, heart disease, thoracic spine disease and chest trauma management. Contraindications for TV thoracoscopic surgery include two aspects, firstly, contraindications for conventional open-heart surgery, such as severe cardiac and pulmonary impairment, malignant mass, extensive tumor metastasis, diffuse or huge lesions that cannot be removed. Secondly, it also includes special contraindications for TV thoracoscopic surgery, such as diffuse adhesions in the pleural cavity (especially dense), huge or invasive chest tumors in the chest wall, chronic abscess chest, etc. In addition, the thoracoscopic treatment of lung cancer is still controversial. Some people believe that lung cancer, especially stage II or above, is a contraindication to thoracoscopic surgery, but different opinions still exist. Television thoracoscopic surgery is demanding in terms of anesthesia. It requires general anesthesia, double-lumen tube tracheal intubation, and ventilation of one lung on the healthy side. A good state of anesthesia contributes to a clear visualization of the surgical field, facilitates surgical operations, improves surgical safety, and reduces operative time. For the surgical method, TV thoracoscopic surgery is very different and much more difficult than conventional open-heart surgery. It is usually performed under three to four small 1.5 cm incisions in the chest wall. The surgeon is looking at the TV to complete the surgery with special surgical instruments, which is the same as extending the surgeon’s eyes into the patient’s chest cavity to perform the surgery. Therefore, the surgical field of view, lesion visibility, scope of surgical resection and safety are even better than those of open thoracotomy. TV thoracoscopic surgery has high requirements for the surgeon, who should first be able to perform conventional open-chest surgery and then receive training in thoracoscopic surgery, which not only helps to master the surgical skills, but also facilitates the timely and correct handling of various situations encountered during surgery. At present, television thoracoscopic surgery has become an important alternative means of diagnosis and treatment of chest diseases. It enables some patients with poor lung function who cannot tolerate conventional open-heart surgery to obtain surgical diagnosis and treatment through thoracoscopy, thus further expanding the indications for thoracic surgery. It is believed that with the improvement of surgical instruments, the accumulation of surgical experience and the standardization of surgical methods and treatment principles, TV thoracoscopic surgery, as a representative procedure of minimally invasive thoracic surgery, will be further popularized and developed.