The procedure was performed with general anesthesia, double-lumen tracheal intubation, and single-lung ventilation. The left or right lateral recumbent position was 90°, the lower part of the chest was routinely placed with soft cushions, the operating bed was slightly shaken to a low head and low foot position (folded knife position), so that the chest was slightly elevated and the rib space was widened, a 1.5-cm incision was made in the mid-axillary line between the 7th or 8th ribs for the observation hole to feed the scope tube, a 3.0-cm incision was made in the upper lobe of the anterior axillary line for the 3rd and the lower lobe for the 4th ribs for the operating hole, and a 1.5-cm incision was made in the subscapular angle line between the 7th or 8th ribs for the secondary operating hole. Single lung ventilation is explored under thoracoscopy. In cases where the nature of the pathology is unknown, a rapid biopsy of the lesion or wedge resection of the lung lobes can be performed first according to the location of the tumor and sent for intraoperative rapid cryopathological examination to determine the nature of the lesion before deciding on the next step of surgery. When lobectomy is performed, the thoracic cavity and lobe adhesions are separated, the hilum and lung fissure are dissected, then the veins and arteries of the lobe are freed, and the pulmonary vessels and bronchi are treated with Endo-GIA/Cutter (small branches of pulmonary vessels can also be clamped with He-mo-lock). The lymph nodes under the bullae are cleared before severing the bronchi, and the diseased lung is carefully removed. The enlarged lymph nodes in the hilum and mediastinum were removed. One case of intraoperative hemorrhage was converted to open chest, which was the third operation in this group and was technically immature. The rest of the surgeries were successfully completed under full thoracoscopy. The average intraoperative blood loss was 115 ml, and the average postoperative drainage was 100-370 ml, with an average of 125 ml. The chest drain was removed 48-72 h after surgery, and the patient was able to get out of bed on his own after the removal of the tube, and the incision pain was mild. There were no postoperative complications. The average length of stay was 11 d. The follow-up period was 1-19 months, and all of them survived well. Discussion Minimally invasive surgery is the trend of surgical development in this century, and various new procedures and techniques have emerged and been developed continuously [1]. Thoracoscopic treatment of pulmonary tumors has been reported [2], but there is still controversy whether the tumor can be cured radically. Our preliminary results suggest that this method is safe and feasible, with the advantages of less trauma, less pain, and faster recovery than conventional open lobectomy, and that the surgical and oncologic principles followed in treatment are the same as those of open thoracotomy. A large body of literature confirms that VATS has significantly fewer perioperative complications compared with conventional open lobectomy for early-stage lung cancer [3], no difference in the extent of lymph node dissection, and no difference in tumor recurrence and long-term survival rates [4]. This clinical evidence has dispelled any doubts about VATS lobectomy for lung cancer, making it increasingly accepted by physicians and rapidly implemented in regions with better thoracic surgery techniques. The technical points of total thoracoscopic lobectomy for lung cancer are: no rib support; completely lumpectomy; anatomical lobectomy + mediastinal lymph node dissection. There are still two major misconceptions about this technique among some doctors in China. One is to mistake thoracoscopic-assisted small incision surgery for thoracoscopic surgery; the other is to subjectively underestimate the level of thoracoscopic technology, therapeutic effect and application potential. The former leads the development of thoracoscopic lobectomy in China astray. Because thoracoscopic-assisted small incision surgery is essentially the same small incision surgery that has been applied at home and abroad for more than thirty years, the thoracoscope is used only as a light source. Even without mastering the basic techniques of thoracoscopic surgery, any surgeon with experience in conventional open-heart surgery can immediately perform these so-called “thoracoscopic lobectomies”. This misconception has led many senior thoracic surgeons in China to neglect learning and studying the basic thoracoscopic techniques and to be satisfied with small incisional direct surgery using the thoracoscope as a light source, which has seriously affected the standardization of thoracoscopic lobectomy surgery in China. The latter has hindered the popularity and development of thoracoscopic lobectomy surgery. The indications for total thoracoscopic lobectomy, as a new and difficult procedure, have been continuously updated and developed over the past 15 years, and still need to be further expanded and improved. in the early 1990s, at the beginning of the application of this technique, it was limited to benign lung diseases (bronchiectasis, etc.) and stage Ia (T1N0M0) lung cancer whose lung function could not tolerate open-heart surgery, and its application was very narrow. After several years of clinical practice, in 1998, McKenna et al. proposed VATS for stage Ia (T1N0M0) lung cancer, which was supported by more and more clinical reports, thus significantly broadening the indications for thoracoscopic lobectomy. In the 21st century, with the accumulation of surgical experience and a large number of clinical reports of good long-term survival rates, total thoracoscopic lobectomy began to change the surgical paradigm for early-stage lung cancer. Since 2006, the NCCN guidelines for the treatment of lung cancer have clearly stated that “VATS lobectomy is a feasible option for resectable lung cancer” [5], which means that the indications for total thoracoscopic lobectomy have basically covered the current internationally recognized indications for the surgical treatment of lung cancer (IA-IIB and partial IIIA), clarifying the status of thoracoscopy in the surgical treatment of lung cancer. It is a promising minimally invasive surgical technique. Therefore, we believe that this procedure should be chosen when encountering the following conditions: patients with stage IA-IIB lung cancer; elderly patients; patients with poor cardiopulmonary function who cannot tolerate conventional open-heart surgery; metastatic lung cancer; lesions ≤5.0 cm. Severe pleural adhesions, especially dense adhesions, and inability to tolerate one-lung ventilation are contraindicated. Although some scholars have reported that thoracoscopic surgery for stage III lung cancer with metastatic mediastinal lymph nodes has achieved satisfactory recent results [6]. However, we believe that conventional open-heart surgery or other treatments should be preferred for stage III or higher lung cancer, because it is inconvenient and dangerous to remove stage III or higher tumors with such a small incision. The surgical operation and issues of attention: choose double-lumen tube intubation to ensure single-lung ventilation, so as to facilitate the exposure and operation of the operative field. It is more convenient to operate from the anterior axilla to the mid-axillary line between 3 or 4 ribs, and the mirror tube is better in the mid-axillary line between 7 and 8 ribs, too high or too low will bring inconvenience to the operation. The size of the main operating hole incision can be larger for beginners, and 3.0 cm is sufficient after proficiency. Thoracoscopic dissection and free lung lesions should be carefully, and vascular ligation should be reliable. It has been proved that the pulmonary vessels and bronchi are very reliable with Endo-GIA/Cutter, and small branches of pulmonary vessels can also be clamped with He-mo-lock, which can save surgical cost. Prospectively, with the maturity of surgical techniques and the development of lumpectoscopic instruments, the previously considered contraindications to surgery such as pleural adhesions, masses ≥5.0 cm, and stage III lung cancer may be accomplished under total thoracoscopy. Radical lung cancer surgery under total thoracoscopy can become the preferred procedure for lung cancer surgery.