The use of televised thoracoscopic lobectomy (VATS) by thoracic surgeons is increasing relative to open-heart surgery, but the adequacy of VATS lymph node dissection and the potential for under-staging has been questioned. The operator learning curve and the volume of VATS procedures may have been overlooked in the previously published literature. A study conducted by American academic Paul C. Lee aimed to examine the impact of cumulative experience with VATS on the adequacy of lymph node dissection in healthcare settings. (Lung cancer online December 1, 2015) The study retrospectively analyzed the database of the host center: 500 consecutive NSCLC patients undergoing VATS were included between 2002 and 2012, divided into 2 groups (first 250 patients vs. second 250 patients) and analyzed for clinical and pathologic factors. Propensity-matched analysis controlled for age, sex, pathological stage and percentage of 1-second forceful expiratory volume, and comparative analysis of patient survival and lymph node dissection adequacy. It was found that patients in the latter group were older (72 vs 69 years, P=0.001), had worse lung function (median 1-second exertional expiratory volume: 83% vs 91%, P<0.001< span="">; median pulmonary carbon monoxide diffusion function: 76% vs 85%, P<0.001)< span="">, and had greater median clinical tumor volume than the former group ( 50px vs 45px, P=0.002), greater median pathologic tumor volume (52.5px vs 50px, P=0.003), more advanced clinical/pathologic staging, total number of cleared lymph nodes (P=0.012) and number of lymph node partitions (P<0.001)< span="">, with similar results on propensity-matched analysis. Matched analysis suggested no statistically significant difference in 3-year disease-free survival between the two groups (85% vs 82%, P=0.187). The study concluded that the cumulative institutional experience significantly influenced the adequacy of lymph node clearance in patients with NSCLC treated with VATS, which may be related to the operator’s VATS learning curve. As the VATS technique matures, more and more patients with combined pulmonary impairment and advanced elderly patients have the opportunity to receive this treatment. Despite the expanded inclusion of older and frail patients undergoing VATS, the disease-free survival of patients did not change.