Video-assisted thoracic surgery (VATS) has undergone a process of occurrence and development, and now the safety and postoperative efficacy of this technology for the treatment of primary lung cancer are gradually recognized by the medical community, and it has unique advantages compared with traditional lobectomy. Our department has performed hundreds of cases of total thoracoscopic lobectomy and achieved good results. The indications are: (1) Stage I, II and some stage III lung cancer, no tumor seen on bronchoscopy, no involvement of the chest wall and no infiltration of the mediastinum, no metastasis in the pleura; (2) no metastasis in the hilar lymph nodes on preoperative examination, enlarged lymph nodes in the mediastinum are not a contraindication to surgery, but mediastinoscopy must be performed before surgery; (3) good general condition, tolerant of one-lung ventilation, no recent myocardial infarction and no serious bleeding tendency, etc. (4) Isolated metastatic lesions less than 4 cm in diameter located in the periphery; (5) No preoperative radiotherapy and no serious thoracic adhesions; (6) Some elderly people with many complications and lung function intolerant to conventional lobectomy. Advantages of comparison with conventional open lobectomy Lobectomy in the anatomical sense can be accomplished under thoracoscopy with lower complication and mortality rates and minimal risk of intraoperative bleeding and incisional recurrence. Thoracoscopic lobectomy is consistent with oncologic standards of care and is currently the ideal procedure for the treatment of stage T1 to T2N0M0 bronchopulmonary cancer, and is a low-complication procedure. The use of thoracoscopic lobectomy in older patients has fewer complications and can better reduce intraoperative and postoperative morbidity. Patients who undergo thoracoscopic lobectomy have lower levels of postoperative stress and are at less risk for perioperative complications. The difference in mean operative time between thoracoscopic lobectomy and conventional open thoracotomy was not statistically significant, and mean blood loss was less with thoracoscopic lobectomy. Thoracoscopic lobectomy and lymph node dissection is safe and feasible and also reduces operative time. Pulmonary function is less impaired in patients undergoing thoracoscopic lobectomy. Thoracoscopic lobectomy significantly relieves the intensity and duration of postoperative pain compared to traditional open-heart surgery, facilitates coughing and sputum removal, thereby reducing respiratory-related complications and shortening the length of hospital stay, allowing patients to recover and return to normal work and life more quickly. Compared with open-heart surgery, the hospital stay, chest tube retention time, and time required to resume preoperative activities were shorter for this procedure. The incidence of pain at 3 weeks postoperatively was significantly lower than in the open-chest group. Thoracoscopic lobectomy reduces patient pain and allows for a faster recovery, especially in those patients who are frail and at high risk.