After nearly 20 years of development, thoracoscopic surgery has become more and more important in the surgical treatment of lung cancer. From the initial biopsy surgery, simple wedge resection until the lobectomy which is now common in clinical practice, and even more complex thoracoscopic lung cancer resection has been reported in academia. Recently I participated in a thoracoscopic surgery competition organized by the Annals of Cardiothoracic Surgery in conjunction with COVIDIEN, judged by surgeons from the United States, and was honored to receive an award for excellence in surgical presentation and an invitation to attend an international symposium organized by the Royal College of Surgeons of Edinburgh, UK, to commemorate the 20th anniversary of thoracoscopic lobectomy The symposium was organized by the Royal College of Surgeons of Edinburgh, UK to commemorate the 20th anniversary of thoracoscopic lobectomy. During the conference, I and several other Chinese colleagues who won the award demonstrated Chinese thoracoscopic surgical techniques to European and American surgeons, who highly appreciated our Chinese surgeons’ surgical techniques. There was a consensus vote on the concept of total laparoscopic surgery. Most of the thoracic surgeons agreed that an operating incision of 8 cm or less without the use of rib retractors is considered total laparoscopic surgery. In terms of tumor size, the majority of surgeons agreed that tumors under 5 cm could be operated on fully thoracoscopically. In terms of lymph nodes, more than half of the surgeons agreed that metastasis to the second station lymph nodes is no longer a contraindication to thoracoscopic surgery (however, giant or fused metastatic lymph nodes are not suitable for thoracoscopic surgery). Thoracoscopic surgical resection can even be performed in some patients with locally advanced disease after chemotherapy, as long as the quality of the procedure is guaranteed to be the same as that of open surgery. The safety and reliability of thoracoscopic lobectomy is now internationally recognized by many thoracic surgeons. The meta-analysis literature with high-level evidence strength also confirms that thoracoscopic surgery is characterized by rapid recovery and minimal trauma, and there is growing evidence that the use of thoracoscopy for early-stage lung cancer can achieve survival outcomes similar to those of conventional surgery. Both in terms of health economics and oncological evaluation indicators, thoracoscopic lobectomy is not inferior to traditional open surgery, and some indicators are even better than open surgery. The future direction of thoracoscopic surgery is to build on the current technology to perform more complex lung cancer surgery, including central lung cancer surgery, total pneumonectomy, segmental lung resection and even combined small incisions for lung cancer resection that invades the chest wall. The situation of Chinese patients is rather unique. A significant number of patients have calcified lymph nodes and may have severe adhesions to the pulmonary vessels due to previous old tuberculosis. If the adhesions are too tight, there may be a risk of hemorrhage if they are separated thoracoscopically, and these patients may not be suitable to continue thoracoscopic surgery and be converted to open surgery.