The da Vinci robotic surgery system has been widely used in clinical practice as the most advanced treatment tool in today’s surgical system. Since the introduction of the world’s most advanced da Vinci robotic surgery system, we have completed more than 30 cases of various types of thoracic surgeries, and now we would like to summarize the indications of da Vinci in thoracic surgery system, so that this most advanced minimally invasive surgery system can be more widely recognized. Pulmonary diseases 1. Small nodules and diffuse pulmonary diseases: With the popularization of clinical CT examination, the detection rate of peripheral pulmonary nodules has increased. These pulmonary nodules, usually less than 3 cm in diameter (especially around 1 cm), may be early-stage 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 pathologic diagnosis. Many patients could not be diagnosed because of the fear of open-heart surgery, and even delayed the treatment of some early lung cancers. “In addition, the da Vinci can be used to diagnose diffuse lung lesions, such as interstitial fibrosis, pulmonary amyloidosis, idiopathic ferritin-containing hyperplasia and diffuse alveolar cell carcinoma, with minimal trauma. It has an irreplaceable role in the diagnosis and differential diagnosis of diseases such as alveolar cell carcinoma; it has significantly improved the diagnosis of these diseases. 2, emphysema and alveolar disease: Traditionally, the treatment of end-stage emphysema has been 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 considered 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, indications and contraindications for surgery are relative; overall, only about 20-30% of patients screened for emphysema eventually meet the requirements and undergo lung volume reduction. “The da Vinci can be performed with four 1CM incisions, which is significantly less invasive and improves the safety of the procedure. Therefore, when available, it is best to choose “da Vinci” lung reduction surgery. 3.Lung cancer: In terms of diagnosis, “da Vinci” can easily solve the problem of difficult diagnosis of early peripheral small lung cancer and the problem of differential diagnosis of cancerous pleural fluid caused by lung cancer. In terms of treatment, wedge resection can be used as a palliative treatment for T1N0M0 (early stage) lung cancer patients who are too old and whose lung function cannot tolerate open-heart surgery; lobectomy is technically mature and is mainly used for the treatment of stage IA (T1N0M0) non-small cell lung cancer and metastatic cancer that requires lobectomy; “da Vinci ” assisted talc pleural fixation can successfully eliminate more than 95% of intractable malignant pleural fluid due to lung cancer. In terms of lung cancer staging, “da Vinci” can not only understand whether there is invasion or implantation of metastasis in the pleura (T stage), but also explore the tumor site, size, external invasion and metastasis in the lung (T and M stage), while ipsilateral mediastinal lymphatic group biopsy is also feasible (left side: 5-10 groups; right side: 2-4 and 7-10 groups); II. Esophageal diseases 1. Esophageal smooth muscle tumor: The traditional removal of esophageal smooth muscle tumor is performed by posterior lateral thoracotomy, which is a typical “small surgery with large incision”. The application of “da Vinci” assisted surgery has changed the surgical route 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, “da Vinci” assisted esophageal myotomy has been able to replace conventional open-heart surgery. 3.Esophageal cancer: the operation generally consists of three parts: firstly, the thoracic segment of esophagus is freed by “da Vinci”; secondly, the stomach is freed by opening; thirdly, the end-lateral anastomosis of the esophagogastric neck is performed by neck incision. 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. III. Status of application of thoracoscopy in the treatment of mediastinal diseases 1. Myasthenia gravis: thymectomy is one of the most effective methods for the treatment of myasthenia gravis (MG). “Da Vinci-assisted 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. In recent years, many domestic and foreign clinical reports 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 “da Vinci” surgery. However, malignant tumors or when the tumor often extends into the interspinous foramen or even invades the dural space should be prohibited or cautiously treated with “da Vinci” surgery. Mediastinal cysts, including bronchial cysts, pericardial cysts, and enterogenic cysts, are among the most common benign diseases of the mediastinum and are also the most suitable conditions for da Vinci surgery, which can easily remove mediastinal cysts of various sizes. Some thymomas, especially non-invasive ones less than 5 cm in diameter, are suitable for removal with the entire thymus under the da Vinci. Some benign mediastinal teratomas can also be removed by “da Vinci”. 3.Other: “da Vinci” assisted thoracic sympathectomy for hand sweating, head sweating, long QT syndrome and other diseases is less invasive and reliable. At the same time, it can also treat a variety of neurovascular lesions and be used for pain relief of advanced cancer. All causes of celiac disease can be treated by “da Vinci” surgery as long as there is no contraindication to surgery; “da Vinci” assisted ligation of the thoracic duct, combined with pleural fixation can effectively treat celiac disease. The indications for the da Vinci robotic surgical system can be classified as follows: I. Diagnostic surgery indications 1. pleural disease pleural effusion, pleural lesions. 2. 2.Pulmonary disease Diffuse lung disease, isolated pulmonary nodules. 3, mediastinal tumors lymphatic system tumors, benign and malignant mediastinal tumors, nodular disease, etc. 4.Pericardial disease pericardial effusion, pericardial biopsy. 5.Thoracic trauma assessment hemothorax, tracheal and bronchial rupture, diaphragmatic hernia, others. 2.Therapeutic surgery indications 1.Pleural disease Malignant pleural fluid, acute abscess chest, benign pleural tumor, etc. 2.Pulmonary disease Spontaneous pneumothorax, some benign lung lesions or metastatic lung tumors, some early primary lung cancer and severe emphysema, etc. 3.Mediastinal diseases benign mediastinal tumors, myasthenia gravis, celiac disease, etc. 4.Esophageal disease esophageal smooth muscle tumor, cardia failure, early esophageal cancer, esophageal diverticulum, esophageal cyst 6.Thoracic trauma hemorrhage, pneumothorax, diaphragm rupture, diaphragmatic hernia, foreign body in the chest, lung laceration. 7, other diseases of the chest neurovascular lesions (hand sweating), congenital prolonged QT interval syndrome, etc.