Lung cancer is the most serious malignant tumor endangering human life and health at present. According to the report of International Association for Research on Cancer (IARC), a branch of the World Health Organization Association, and the American Cancer Society, the incidence rate of lung cancer in China in 2011 was 45.0/100,000 for men and 19.9/100,000 for women in the world population adjustment, and the incidence rate of lung cancer has shown a significant increasing trend in recent years. Surgical treatment is still the main means, and the standard procedure for lung cancer is lobectomy + systematic mediastinal lymph node dissection. At present, the posterior lateral chest incision is the standard open incision, the disadvantage of which is that the skin incision is 24-750px long and the main muscles of the chest wall and the ribs need to be cut off or severed. If the action of opening the chest is rough or the chest is closed hastily, the activity of the upper limbs is easily restricted and the incision is painful continuously after the operation, so that some older patients with poor lung function lose the opportunity to operate because they cannot tolerate the operation. With the continuous improvement of device surgery technology, the development of minimally invasive surgery technology has been promoted. At present, minimally invasive surgery for lung cancer mainly includes three types of surgical procedures, namely, complete television thoracoscopic surgery (C-VATS), thoracoscopic-assisted small incision surgery (a-VATS), and small incision open-chest surgery (MT). Since the 1st thoracoscopic lobectomy with complete dissection of the hilum in 1992, this procedure is now widely performed, but many surgeons are not yet comfortable with this technique, so less than 10% of lobectomies are done thoracoscopically. Thoracoscopy is still more controversial in the following aspects. There are still more controversies. The current situation and progress of thoracoscopic application in lung cancer treatment are reviewed. What is the length of the auxiliary incision? Are rib spacers used? Is the operative field observed through the adjuvant incision or only through the monitor? C-VATS has the following characteristics: (1) completely lumpectomy, anatomical lobectomy + mediastinal lymph node dissection. (2) The surgical incision is significantly shortened, and the main operating hole of TV thoracoscopic surgery (VATS) for lung cancer is shortened to 3~125px, with less muscle severance in the chest wall, less bleeding, and less scarring after healing. (3) No stretching of the ribs, no pulling on the ribs, and fast postoperative recovery. (4) Convenient specimen removal. a-VATS is a small intercostal incision made with the assistance of thoracoscopy, and the operator can combine VATS and MT through a small intercostal incision to complement each other and make it easier to perform anatomical lobectomy. Indications and contraindications The indications are mainly for <75px stage I peripheral lung cancer and some stage IIa lung cancers, no serious adhesions in the chest cavity and complete lung fissure development. Contraindications are large tumors, central lung cancer, mediastinal lymph node metastasis, intolerance to one-lung ventilation anesthesia, and severe thoracic adhesions. The indications for thoracoscopic lobectomy have been expanding with the continuous development of instruments and equipment. Bu Liang et al. reported that the differences between total thoracoscopic lobectomy for lung cancer ≥125 px in diameter and those with diameter ≥125 px and those with diameter <125 px were not statistically significant in terms of the rate of intermediate chest opening, operative time, intraoperative bleeding and complication rate, operative thoroughness, number of lymph node dissection stations, number of lymph nodes, local recurrence rate, and 1-year survival rate. There was no statistically significant difference in terms of comparison (P > 0.05), and total thoracoscopic lobectomy was considered safe and reliable for the treatment of non-small cell lung cancer (NSCIC) with partial tumor diameter ≥125 px. Since Kirby et al. first reported thoracoscopic lobectomy, thoracic surgeons began to try to apply thoracoscopy to more complex lung cancer procedures, and Cedars-Sinai Medical Center performed thoracoscopic sleeve lobectomy in 13 cases when thoracoscopic lobectomy reached 1500 cases. Nakanishi reported 134 cases of thoracoscopic lobectomy, of which 5 cases had concurrent Schmid et al. reported thoracoscopic right upper lung lobectomy with da Vinci robot-assisted thoracoscopy, which took 364 min to complete, and the chest tube was removed at 9 d postoperatively. And lobectomy is a typical and representative procedure of thoracoscopy. Third, the oncologic significance of thoroughness Some thoracic surgeons have concerns about the oncologic thoroughness of thoracoscopic lobectomy, and most current opinions are that it is feasible for stage I NSCLC, controversial for stage II, and contraindicated for stage III. The 2006 edition of the National Comprehensive Cancer Network (NCCN) states that radical lung cancer surgery by any route requires the ability to complete 3 groups of N2 lymph node dissection, D ‘Amico et al. analyzed the NCCN data, and the differences in the number of stations and number of mediastinal lymph nodes cleared by thoracoscopic lobectomy compared with conventional open surgery were not statistically significant (P > 0.05). Yan et al. did an exhaustive Meta-analysis, and the differences in the incidence of persistent air leak, arrhythmia, pneumonia, death, and local recurrence between thoracoscopic lobectomy and conventional open surgery were The difference in incidence was not statistically significant (P > 0.05), and the difference in systemic recurrence rate and 5-year morbidity and mortality rate was statistically significant (P < 0.01), which concluded that in early NSCLC, thoracoscopic hilar and mediastinal lymph node dissection was comparable in scope and extent compared with conventional surgery and was acceptable for patients with clinical early NSCLC. Sagawa et al. in Japan performed thoracoscopic lobectomy and mediastinal lymph node dissection first in 29 patients with stage I lung cancer, and then another group of thoracic surgeons performed lymph node dissection again using a standard posterior lateral incision open chest, and the results showed that the thoracoscopic right-sided surgery removed an average of 40.3 (23-73) lymph nodes and missed an average of 1.2 (0-6) lymph nodes; the thoracoscopic left-sided surgery removed an average of It was concluded that thoracoscopic surgery only left 2% to 3% of lymph nodes, which is acceptable in stage I lung cancer. Comparison between thoracoscopic and traditional open-heart surgery for lung cancer Thoracoscopic lobectomy has the advantages of less trauma, less intraoperative bleeding, shorter drainage time and shorter hospital stay compared with open-heart surgery. The effect of thoracoscopy on systemic immune function, Tajiri et al. compared 63 cases of a-VATS, 168 cases of C-VATS, and 61 cases of lobectomy with standard postero-lateral open thoracotomy and found that creatine phosphokinase and C-reactive protein levels, blood loss, pain visual analog scores, and pain medication dosage were lower in the former two than in the open thoracotomy group. yim et al. measured blood levels of tumor necrosis factor, leukocyte interleukin (IL)-1, IL-8 and IL-10 in blood, the results showed that the VATS group was significantly lower than the open-chest group, and the difference was statistically significant (P < 0.01). V. Safety of thoracoscopic lobectomy McKenna and Luo Xiaoyang reported 1100 cases of thoracoscopic lobectomy completed in 12 years, resulting in an operative morbidity and mortality rate of 0.8%, no intraoperative death due to bleeding, and only 2.5% of intermediate open-heart surgery, with a median postoperative hospital stay of 3 d and no postoperative complications in 84.7% of patients. One report comparing the safety of 66 VATS (VATS group) and 686 conventional open-chest surgeries (open-chest group) showed that the VATS group had less pulmonary atelectasis (P=0.035), shorter chest tube drainage time (P=0.029) and hospital stay (P<0.001), and similar surgical morbidity and mortality rates (0 in the VATS group and 1.6% in the open-chest group, P=1.000). Hennon et al. reported no statistically significant differences in intraoperative blood loss, operative time, major complications, length of hospital stay, and survival rate between VATS and conventional open-heart surgery in patients with late-staged lung cancer (P > 0.05). Thoracoscopy lacks conventional timely and effective hemostasis methods and mostly requires timely intermediate open-heart surgery. Park et al. reported 738 cases of thoracoscopic lobectomy, of which 34 cases were intermediate open-heart surgery, commonly due to dense adhesions of lymph nodes and blood vessels. Although thoracoscopic techniques cannot completely replace open-chest surgery in lung cancer surgery, they have unparalleled advantages in diagnosis, staging and stage I lung cancer, and the advantages of thoracoscopy and traditional open-chest surgery are complementary. VI. Long-term results as radical tumor resection Yamamoto et al. reported 325 cases of thoracoscopic lobectomy, of which 21 cases (6.5%) were converted to open thoracotomy with 66 months of postoperative follow-up. Among them, the overall survival and 5-year tumor-free survival rates were 85% and 83% for stage IA, 69% and 64% for stage IB, 48% and 37% for stage II, and 29% and 19% for stage III, respectively, and the 5-year survival rates of thoracoscopic lobectomy and open thoracotomy were considered comparable. Most scholars believe that the current evidence supports that thoracoscopic lobectomy for early-stage NSCLC can achieve complete oncological resection with conventional open-heart surgery, and that the long-term outcome of thoracoscopic treatment of stage I lung cancer is satisfactory. The operation of thoracoscopic lobectomy varies widely among medical centers, making it difficult to evaluate this technique, and long-term outcomes are controversial.Fajah et al. concluded that due to artificial factors such as lack of randomized clinical trials and case selection bias, VATS patients had smaller masses (P < 0.001), a higher proportion of stage I (P = 0.030), a higher proportion of lymph nodes resected than patients undergoing traditional open thoracotomy ( P < 0.001), more experienced surgeons (P < 0.001), and greater surgical volume at their hospitals (P < 0.001); after adjusting for differences between groups, the risk of early death and long-term morbidity and mortality were comparable between the two groups; similar conclusions were reached by Nwogu et al. of Roswe II Park Cancer Institute. CALGB39802 is the first prospective multicenter clinical study on standard thoracoscopic lobectomy, which standardized thoracoscopic lobectomy to one 4- to 200-psi incision, two 12.5-psi operating holes, and no rib support. A total of 128 cases with peripheral pulmonary nodules ≤75 px in diameter were enrolled, 111 of which were stage IA NSCLC. 96 cases were successfully performed thoracoscopic lobectomy with a median operative time of 130 min, median chest drainage time of 3 d, and 3 deaths, all unrelated to thoracoscopy. Although VATS has been used in the field of lung cancer surgery for more than 10 years, it has not been standardized and universally applied. Completing thoracic surgery under thoracoscopy with the same quality as traditional open-heart surgery has become the goal pursued by thoracic surgeons in the 21st century. The one-way total thoracoscopic lobectomy proposed by Lunxu Liu et al. has simplified and made the difficult thoracoscopic surgery easy to perform, marking the maturity of thoracoscopic lobectomy in China. With the continuous accumulation of clinical experience, improvement of surgical instruments and surgical techniques, VATS will be applied by more and more clinicians and the role of thoracoscopy in the treatment of lung cancer will be further expanded.