In the past, when it comes to thoracic surgery, people easily associate it with long incisions and shiny scalpels. Especially large incision surgery trauma caused by severe pain will make patients and their families shudder. With the continuous progress of medical science and technology, the application of modern television camera technology and high-tech surgical instruments and equipment, thoracic surgeons have been able to complete complex surgery in the chest wall under a small incision in the thoracic wall, including television-assisted thoracoscopic surgery (VATS) as a representative of the surgery opened up the thoracic surgery of the “minimally invasive era”. Many patients are no longer nervous about chest surgery. With the wide application of minimally invasive techniques in the field of thoracic surgery, the “minimally invasive era” of thoracic surgery has begun. Safer surgery, less trauma, and faster recovery are the goals pursued by thoracic surgeons, and we hope that our minimally invasive techniques will bring benefits to more patients. Early peripheral lung cancer can be treated with VATS first. 73-year-old Ms. Yao, a teacher in Yuhang District, accidentally found a 3-cm nodule outside the upper lobe of her right lung in a physical examination, and was initially diagnosed with right upper peripheral lung cancer, for which surgical resection was the first choice of treatment. However, considering her advanced age and the fact that she has been suffering from chronic bronchitis and diabetes for many years, she was afraid that she could not tolerate the surgery, which undoubtedly put Ms. Yao and her family in a dilemma. For an elderly patient like Ms. Yao who is in poor physical condition, traditional open heart surgery would cause great damage to the patient’s chest wall muscles and intercostal nerves, resulting in intense pain in the short term and long-term discomfort after the surgery. Post-operative patients are afraid to cough due to pain or coughing weakness, resulting in poor sputum evacuation, which can lead to a series of complications such as lung infections, pulmonary atelectasis, respiratory failure and so on. After thorough preoperative preparation, Mr. Yao chose VATS surgery. The surgery was done under thoracoscopy, only 3 small holes were made in the chest wall, without cutting the ribs or opening the incision. The right upper lung was successfully cut off in one hour, and the specimen was immediately sent to rapid frozen pathology examination, which resulted in “poorly differentiated adenocarcinoma”, and systematic mediastinal lymph node dissection was carried out under the thoracoscopy immediately. After the surgery, Mr. Yao only felt mild pain in the chest, which did not affect his breathing and coughing, and his recovery was very smooth. Advantages of minimally invasive surgery with VATS: Lung resection under VATS has become safer and faster, and radical lung cancer surgery and lymph node dissection under VATS can be as thorough as open thoracic surgery, and its 5-year survival rate has reached or even higher than that of traditional incision. Literature reports that the 5-year survival rate of VATS for stage I lung cancer is 87.7%-97%. VATS also has the advantages of small trauma, fast recovery, less bleeding and blood transfusion, small impact on cardiopulmonary function, short switching time of chest, and fewer postoperative complications, which is in line with the requirements of modern minimally invasive surgical technology. Therefore, this technique can be the first choice for peripheral early lung cancer. Thoracoscopy and mediastinoscopy have become a powerful weapon for clarifying difficult chest diseases Last year, Hangzhou Daily reported two cases of patients misdiagnosed as advanced lung cancer in foreign hospitals were diagnosed as tuberculosis by mediastinoscopy in our hospital, which immediately attracted many patients with advanced lung cancer to come to the hospital for re-diagnosis. Mediastinoscopy is a minimally invasive surgery of the chest. Mediastinoscopy can be used to obtain mediastinal lymph nodes that were previously difficult to obtain by other means, and it can clarify some chest diseases with unknown diagnosis. For tumor patients, mediastinoscopy can detect mediastinal invasion and lymph node enlargement that cannot be detected by imaging, which can be used to stage the disease more accurately and exclude unnecessary open chest exploration. Our hospital is the earliest hospital to carry out this technology in Hangzhou municipal hospital. With the development of modern diagnostic imaging technology and the popularization of health checkups, the discovery rate of nodular lesions in the lungs has risen significantly, and the qualitative diagnosis of such lesions has always been a tricky problem, which suggests a variety of disease possibilities such as inflammatory pseudotumor, tuberculosis ball, lung misshapen tumors, lung cancer, lung metastasis, etc. The correct diagnosis has a direct relationship with the diagnosis of lung cancer and lymph node enlargement. The correct diagnosis is directly related to the choice of treatment plan and its prognosis. The application of thoracoscopy in recent years provides a reliable pathological diagnosis basis for the qualitative confirmation of such lesions in the lung. In this case, VATS pulmonary nodule resection is both diagnostic and therapeutic. For diffuse lung disease VATS lung biopsy is considered indispensable to confirm the diagnosis of patients with undiagnosable or incompletely diagnosed lung lesions. Intractable pleural effusion through VATS can both clarify the cause and control pleural fluid Pleural effusion has a complex etiology and is often one of the diseases that are difficult to diagnose clinically, and its definitive diagnosis is subject to pathologic examination. Many unexplained pleural effusions are still unable to clarify the etiology through routine laboratory tests, percutaneous pleural biopsy, and cytologic examination of pleural fluid, which then affects the treatment, and many patients lose their chances of treatment during the lengthy diagnostic process. With VATS, the whole pleural cavity can be observed, including the wall pleura, lung surface, mediastinum and diaphragmatic pleura, and multiple-point biopsies can be performed under direct visualization, thus resulting in a high diagnostic rate. In the literature, the diagnostic rates of pleural biopsy by needle aspiration, pleural fluid cytology and VATS are 6%, 31% and 94%, respectively. This shows that the accuracy of VATS in the diagnosis of pleural diseases is unrivaled by other methods. VATS also has obvious advantages in the treatment of recalcitrant pleural effusion. The traditional treatment methods are repeated thoracentesis and aspiration, chest tube drainage, and pleural cavity injection of drugs pleural fixation. However, studies have shown that simple thoracentesis requires re-puncturing in 4.2 days on average, and about 90% of patients are difficult to maintain by puncture. Although the placement of closed chest drainage can exhaust the pleural fluid, but the recurrence rate is still as high as 80% within 30 days after extubation, and it can also cause a large amount of loss of body fluids and nutrients, so that the patient will soon enter the state of malignant fluid. Thoracoscopic surgery has the characteristics of small trauma, it can not only fully loosen the adhesion, peel off the cellulose, so that the lung tissue is fully re-tensioned, but also injected with anticancer drugs or talcum powder to fix the pleura, evenly cover the entire pleural cavity, leaving no dead space, prompting the extensive adhesion in the pleural cavity, shorten the drainage time, and reduce the loss of protein. After our VATS treatment, the effective control rate of intractable pleural effusion reaches 93%, and the recent effect is satisfactory. At present, VATS has gradually become the preferred method to control malignant pleural fluid. Tuberculous pleurisy early treatment by VATS can speed up the absorption of pleural fluid, reduce pleural adhesion hypertrophy Clinically, many patients with tuberculous pleurisy can not be clearly diagnosed by routine examination, or there is pleural adhesion segregation can not be pumped out of the pleural fluid, thoracoscopic examination and treatment of such patients is very meaningful, not only to be able to clarify the diagnosis, but also have a very good therapeutic effect. Thoracoscopy can pump out pleural fluid at one time, relieve the local blood and lymph circulation obstacles, and promote the absorption of exudate; rapid elimination of pleural fluid, eliminating the stimulation of the pleura, reducing pleural hypertrophy; flush out the proteins in the pleural cavity, reducing the colloid osmotic pressure in the pleural cavity, reducing the continued exudate of pleural fluid; flush out the inflammatory mediators in the pleural cavity, alleviating the inflammatory response of the pleura, and reducing the exudate; cut off the adhesion, preventing pleural space It is beneficial to the drainage of pleural effusion. In the past 2 years, many patients with tuberculous pleural effusion were diagnosed in time after VATS treatment in our department, the pleural fluid was controlled in a short period of time, which rapidly relieved the symptoms, shortened the treatment period, and reduced the occurrence of pleural hypertrophic adhesions. Therefore, we believe that VATS is of great clinical value for tuberculous pleurisy in terms of clarifying the diagnosis, rapidly controlling the condition, reducing pleural adhesion and hypertrophy, and subsequently reducing the occurrence of sequelae that affect respiratory function. The therapeutic role of VATS on pneumothorax and bronchopleural fistula Studies have shown that the first episode of spontaneous pneumothorax can be handled by simple chest puncture or closed chest drainage, but the recurrence rate is up to more than 20%, and the recurrence rate of multiple recurrent pneumothorax can be up to 50%-80%, and if the air leakage lasts for more than 3d without improvement, the possibility of self-healing with tubes released has been low. In recent years, VATS has been popularized for the treatment of pneumothorax, and trans-thoracoscopy can not only observe pneumothoracic fistula, lung surface pulmonary alveoli and bronchopleural fistula, but also can be used to resect the diseased tissue with endoscopic suture cutter or suture and ligate pulmonary alveoli and air leakage under the luminal microscope, but also use the trans-thoracoscopic pleuroperitoneal fixation, which is good for the majority of pneumothorax, and the small bronchopleural fistulas, with a very low recurrence rate in the long term. The recurrence rate is extremely low. Bronchial artery embolization (BAE) intervention for hemoptysis Hemoptysis is a common critical condition in tuberculosis and respiratory clinics. If the treatment is not timely and in place, it is easy to asphyxiation, hemorrhagic shock and other deaths, and the literature suggests that the mortality rate of hemoptysis in internal medicine is 22%-50%, and the mortality rate of high-risk patients is even 78%-80%. Currently, the main treatment means are internal medicine, surgery, bronchial artery embolization intervention. Internal medicine is slow and ineffective in stopping bleeding, hemoptysis is easy to recur, and some comorbidities limit the clinical use of medicine. Surgery has a high morbidity and mortality rate and complications, and is also limited by the general condition of the patients. Bronchial artery embolization for hemoptysis is a rapid, safe and effective method, and can be the first choice for hemoptysis treatment. We have saved many patients with hemoptysis every year by this technique.