Video-assisted Thoracoscopic Surgery (VATS) has become a mature thoracic surgical technique and one of the commonly used surgical methods in clinical practice after 15 years of continuous development, and the proportion of its application reflects the technical level of thoracic surgery of a hospital to a certain extent. The clinical application of TV thoracoscopic surgery has changed the treatment concept of some thoracic surgical diseases, especially in redefining the surgical indications, contraindications and surgical access for some diseases, and at the same time, with the introduction of new technological means, new ideas and new methods, the thoracoscopic technology itself has become more mature and rational. Lung is the most used organ for thoracoscopic surgery, usually accounting for more than 70% of the total number of thoracoscopic surgeries in the same period, and it is also one of the most suitable sites for thoracoscopic surgery. Zhu Huaiyang, Oncology Center, Shandong Chest Hospital, Shandong Province, China 1. Small intrapulmonary nodules and diffuse lung diseases: with the popularization of clinical CT examination, the detection rate of peripheral pulmonary nodules has increased. These nodules, which are usually less than 3 cm in diameter (especially around 1 cm), may be early lung cancer, benign lung tumors, or inflammatory masses in the lungs; their common feature is that clinical diagnosis is very difficult. The success rate of percutaneous lung aspiration biopsy for such small nodules is low, and there are many complications, which can only be diagnosed by open-heart biopsy in the past. In the past, only open chest biopsy could be used for pathologic diagnosis. Many patients could not be diagnosed due to the fear of open chest surgery, which even delayed the treatment of some early lung cancers. Television thoracoscopic surgery, which can accomplish the same effect of lung wedge resection as open thoracic surgery with minimal trauma, has been well received by patients and physicians; therefore, the number of cases in which thoracic surgeons contacted and treated peripheral lung nodules has increased significantly in recent years. Meanwhile, thoracoscopy has an irreplaceable role in the diagnosis and differential diagnosis of diffuse lung lesions, such as interstitial fibrosis, pulmonary amyloidosis, idiopathic ferritin deposits and diffuse alveolar cell carcinoma, which significantly improves the diagnostic level of this type of disease. 2. Emphysema and alveolar disease: Traditionally, the treatment of terminal emphysema is mainly based on internal medicine, but the efficacy of the treatment is extremely limited, and the condition is still Progressive deterioration. In the past, lung transplantation was the only means of surgical treatment, but it was difficult to promote due to many problems. In the last decade, lungvolume reduction surgery (LVRS) has been reapplied to treat emphysema, achieving satisfactory results and bringing hope for the treatment of emphysema. It is currently believed that the ideal surgical patient should meet the following three conditions: (1) a series of pathophysiologic changes caused only by severe emphysema; (2) uneven distribution of lesions, the presence of resectable areas of severe lesions and located in the upper lobes of the lungs; and (3) lung hyperinflation. To date, indications and contraindications for surgery are relative; in general, only about 20-30% of patients screened for emphysema are ultimately eligible for and undergo lung reduction. Currently, the two commonly used surgical routes are median sternotomy and thoracoscopy, the latter being significantly less invasive, with improved surgical safety and essentially equivalent efficacy. The indications for surgery for alveolar disease include: (1) alveoli causing dyspnea; (2) although the symptoms are mild, the alveoli are larger than 1/2 of the volume of one side of the chest; (3) alveoli combined with more than 2 episodes of spontaneous pneumothorax; (4) although the first episode of pneumothorax, but one of the following conditions, (1) persistent leakage of air from the lungs, i.e., the lungs do not regenerate after >72 hours of effective closed drainage of the chest, or the air leakage is persistent; (2) both sides of the lungs are not stable or the air leakage is persistent; (3) both sides of the chest are not stable. persistent air leakage; (2) bilateral simultaneous or sequential episodes of spontaneous pneumothorax; (3) patients with special jobs, such as divers, pilots, field workers, etc., as well as the lack of basic medical care in the region; for athletes and college and high school students may also be appropriate to prevent relaxation of the indications for surgery; (4) spontaneous hemopneumothorax; (5) spontaneous tension pneumothorax. Thoracoscopic alveolar resection is usually very easy, but when the alveolus is huge, or the pleural adhesion is serious, or the alveolus is all over the lung surface, the treatment is very tricky, and sometimes it needs to be transferred to a small incision open thoracotomy.3. Lung cancer: In the diagnosis, thoracoscopy can easily solve the diagnostic difficulties of early peripheral small lung cancer and the differential diagnosis of carcinogenic hydrothorax caused by lung cancer. In terms of treatment, lung wedge resection can be used as a palliative treatment for T1N0M0 lung cancer patients with high age and lung function unable to tolerate open thoracotomy; lobectomy is technically mature, and it is mainly used for the treatment of stage IA (T1a, bN0M0) non-small-cell lung cancer and metastatic cancer requiring lobectomy; however, with the maturity of the surgical operation technology and its continuous improvement, the indications for lung cancer surgery have also been relaxed; thoracoscopy can easily solve the problem of difficult diagnosis of early peripheral small lung cancer and the problem of differential diagnosis of lung cancer-induced pleural fluid. However, with the maturity and continuous improvement of surgical techniques, the indications for lung cancer surgery have been relaxed; thoracoscopic talcum powder pleural fixation can successfully eliminate more than 95% of the persistent malignant hydrothorax due to lung cancer. In terms of lung cancer staging, thoracoscopy can understand whether there is any invasion or planting metastasis in the pleura (T stage), and it can also investigate the tumor site, size, invasion and metastasis in the lung (T and M stage), and at the same time, it is also feasible to biopsy ipsilateral mediastinal lymph node groups (left: 5-10 groups; right: 2-4 and 7-10 groups); however, compared with mediastinoscopy, it requires double-lumen tube intubation, and it can not simultaneously biopsy the opposite lymph node, and the complications are relatively high; however, compared with mediastinoscopy, it requires dual-lumen tube insertion, and cannot simultaneously biopsy contralateral lymph nodes, and the complications are relatively high. and complications are relatively high; therefore, it is only selectively used for staging lung cancer and cannot yet replace mediastinoscopy.