The mediastinum, with its complex structure and multifunctional cells, is the most complex region of the body in which tumor types occur and contains a group of lesions of varying morphology, size, and nature. The most common mediastinal tumors are thymoma, neurogenic tumors, primary cysts, lymphoma and germ cell tumors, most of which are benign. In principle, mediastinal tumors should be treated surgically once they are diagnosed. However, the traditional surgical method has great damage to the muscles and sternum of the chest, many complications, obvious postoperative pain and slow recovery, which is difficult for patients to accept. In recent years, with the application of modern thoracoscopic surgery, a new way has been opened for the treatment of mediastinal tumor. Compared with other surgeries in thoracic surgery, mediastinal tumor resection is a kind of “destructive” surgery without “reconstruction” or “repair”, so it is more suitable to be operated under thoracoscope. According to the treatment experience of our group, we have experienced the following advantages of thoracoscopic surgery for mediastinal tumor: 1, less trauma, less pain, faster recovery, and in line with the cosmetic requirements; 2, clear surgical field of view, magnification of microstructure, safe handling of the relationship with important structures, the field of view involving all parts of the mediastinum, almost no dead angle; 3, multiple points can be taken, and the specimen is large enough to facilitate routine pathological examination, histochemical examination and electron microscopic scan to determine the extent of the tumor. The specimen is large enough for routine pathological examination, histochemical examination and electron microscope scan to determine the nature of tumor and guide chemotherapy; 4. The mediastinal tumor resection can be performed without or with less disposable consumables, and the hospital stay is significantly shorter than that of traditional surgery, which significantly reduces the overall cost. The average postoperative hospital stay was 5.5 d. All patients recovered well after surgery, and no significant complications occurred, which achieved a more satisfactory outcome. Although thoracoscopic surgery has the above-mentioned advantages, it cannot completely replace traditional surgical methods. We should strictly grasp the indications for surgery. We routinely take frontal and lateral chest X-ray and chest CT enhancement scan before surgery, which can clarify the nature, location, size, whether the tumor is intact, whether there is outward infiltration and the relationship with surrounding organs, and judge the difficulty of thoracoscopic surgery. Preoperatively, the decision of whether to perform thoracoscopic surgery should be made by judging the benignity and malignancy of the tumor. Malignant or invasive tumors generally require open-heart surgery, but thoracoscopy can be used for intraoperative exploration or biopsy. Preoperative CT and MRI examination is especially important for neurogenic tumors. If it is found that the tumor grows into the spinal canal through the intervertebral foramen, it is easy to damage the nerve root or spinal cord when separating the tumor, and it is difficult to completely remove the intravertebral canal part of the tumor, which should be regarded as a contraindication to thoracoscopic surgery. The size of the tumor and thymoma with severe muscle weakness or not are not the necessary basis for choosing thoracoscopic surgery. For larger cystic tumors, we have achieved the purpose of improving the surgical field, facilitating operation and preventing extravasation of cystic fluid through intraoperative volume reduction. For tumors that are difficult to be removed, the surgery has been successfully completed by improving the specimen removal technique or appropriately extending the surgical hole. At present, it is generally believed that huge mediastinal tumors are not suitable for thoracoscopic surgery, and mediastinal tumors with diameters greater than 10 cm are usually discussed as huge tumors in clinical practice. Due to the huge tumor, there are often compression and invasion of surrounding organs, and heavy adhesion between tumor and blood vessels, etc., which can easily damage blood vessels and cause adverse consequences during surgery. Such patients should take safety as the first priority and should be removed by conventional open-heart surgery. For patients with thymoma combined with severe myasthenia gravis, it has been proved that thoracoscopic total thymectomy and mediastinal fat clearance is feasible. 5 patients with severe myasthenia gravis were followed up in our department or neurology department for 1 to 16 months, and their symptoms were completely relieved or improved significantly with satisfactory results. Intraoperative bleeding used to be a major threat in thoracoscopic surgery, but with experience, this problem has been better resolved. If inadvertently large bleeding results, maintaining a clear view is the key, and then trying to control it with hemostatic forceps and titanium clips to turn “large bleeding into small bleeding” and try to avoid turning “large bleeding into large bleeding”, and then stopping the bleeding completely with sutures or ligatures as appropriate. If it is difficult to control under the mirror, it should not be forced, and small incision or direct transfer to open the chest should be added in time to ensure safety. In conclusion, thoracoscopic surgery provides a safe and effective choice for the diagnosis and treatment of mediastinal tumors, but as a surgical route, it is still necessary to follow the principles of surgical oncology, strictly grasp its indications and contraindications, continuously improve surgical skills, and pay close attention to the long-term efficacy, so that it can play its proper role in the diagnosis and treatment of mediastinal tumors.