Thoracoscopic minimally invasive lung surgery, in China, started in the 1990s. It has gone through the budding period (1992-1994), the growth period (1995-1999), the stable period (2000-2005), to the mature period (2006-present). From the beginning when only simple procedures such as lung biopsy, alveolar resection, lung wedge resection, hemopneumothorax treatment and sympathectomy could be done, through the efforts of the majority of thoracic surgeons for more than twenty years, to the current complex radical lung cancer surgeries such as lobectomy, lobectomy of lung segments, lung lobe sleeve and double sleeve resection and systemic lymph node dissection. Minimally invasive surgery is also performed in a variety of ways. There is the Wang’s approach founded by Prof. Wang Jun of Peking University People’s Hospital, and the one-way thoracoscopic lobectomy advocated by Prof. Liu Lunxu of Huaxi. With the development of minimally invasive technology, the instruments for minimally invasive surgery are constantly innovated and improved to meet the needs of surgery. The surgical incisions vary from four-hole, three-hole, two-hole and single-hole methods. The use of thoracoscope has transitioned from the earliest role of only flashlight-type illumination in small incisions to telescopic observation of the lung surgery field to the current role of magnifying glass on the TV screen to observe the structure and specific operation of the lung. At first, there was a suspicion that minimally invasive surgery was not thorough in clearing lymph nodes. With the maturity of the operation technique, thoracoscopic clearance of lymph nodes, because of its magnifying effect, can be seen more clearly than conventional surgery, so it can be cleared more thoroughly. Due to the mastery of lumpectomy suture technique, reconstruction anastomosis of bronchi and blood vessels after lung sleeve resection has been carried out successively in major hospitals in the past decade, which better reflects the principle of lung surgery of maximum lesion removal and maximum preservation of lung function. A number of master experts have also emerged nationwide, and through various academic exchanges, study sessions and training courses, minimally invasive lung surgery has been commonly carried out throughout the country, and the operation techniques are becoming more and more perfect and mature. The key to minimally invasive lung surgery is safety, and the number of holes is only the way, so it is not necessary to be demanding. The number of holes is only the way, and it is not necessary to be demanding. The purpose is to remove the tumor safely, exactly and completely. Since the blood vessels of the lung are directly connected to the heart, lobectomy is mainly a treatment of pulmonary blood vessels. Even if there is a pinhole-sized injury to the pulmonary artery, poor treatment can cause hemorrhage, so preventing bleeding is the key to successful surgery. The indications of minimally invasive lobectomy, with the maturity of individual techniques, the size of tumor is relative, but the relationship between pulmonary vessels and metastatic lymph nodes is the main basis of whether minimally invasive can be done. If the metastatic lymph nodes are closely infiltrated with blood vessels and there is difficulty in separating them, then it is necessary to expand the incision intraoperatively and it is safer to separate the blood vessels with the assistance of thoracoscopy. Usually the lymph nodes only infiltrate the vascular sheath, so it is safer to separate the vessels within the sheath. Thoracoscopic lobectomy is generally performed in a sequence of easy first and then difficult. After incising the pulmonary ligament and the anterior and posterior mediastinal pleura of the pulmonary hilum, the pulmonary veins are freed first, the suction is held in the left hand, and the electric hook is held in the right hand. The electric hook hook hooks up the vascular sheath and connective tissue, and the suction pushes away the vessels and widens the gap so that there is a certain distance between the electric hook and the vessels before electrocautery incision. The value of electrocautery is usually around 40, too large will hit and penetrate the tissue. The incision is usually made along the longitudinal axis of the vessel to a certain length. The electric hook is inserted into the sheath of the vessel dorsally, turned over, and the tip is used to pick up the sheath of the vessel, and the suction is placed between the hook and the vessel to protect the vessel, and the sheath is cut after the gap is enlarged. Each time cut, hook up less tissue, see clearly before cutting, when both sides of the vessel and the back of the connective tissue is cut, then it is easy to cut through with right-angle forceps. When dealing with the pulmonary artery, the cutting sutures should be gentle when crossing the back of the vessel, and do not flip and swing sideways after closing to avoid injury. These skills are gradually improved in practice, and practice makes perfect. Characterization and localization of lesions. Since CT scan of the chest and detection of tumor indicators are commonly used in physical examination, GGO less than 5 mm can also be detected. Whether to follow up or operate is considered according to the size, morphology and density of the tumor. If malignancy is suspected, 3D CT reconstruction of the lesion can be further examined. Nodules larger than 8 mm can be PET-CT, nodules located superficially in the lung can be performed by percutaneous lung puncture, deeper nodules can be biopsied by bronchial puncture, and EBUS-TBNA can be performed if there are enlarged lymph nodes under the mediastinum or bulge, and nodules in the periphery of the lung can be sent for frozen section after wedge resection of the lesion in minimally invasive surgery. The nodules in the periphery of the lung can be examined in a minimally invasive procedure after wedge resection of the lung. Try to obtain a clear pathological diagnosis before lobectomy to avoid unnecessary damage and trouble. If GGO needs to be followed up, usually once every 2-4 months, and if the nodule diameter is found to increase by 25% during the follow-up, the volume has increased by a factor of 1. The doubling time of malignant tumors is usually around three months, and if there is no change in two years, the malignancy is less likely, but there are also malignant lesions that increase rapidly after five years. If the solid component of nodules increases and the density increases during the follow-up, the possibility of malignancy is high, and surgery should be considered at this time. In some cases, it is not easy to obtain a pathological diagnosis before surgery, such as small and deep nodules, or close to pulmonary vessels, cardiac vessels, or scaphoid obstruction that prevents puncture, etc., the family should be specially informed before surgery, and only when they understand and actively request surgery, they can sign for lobectomy. In minimally invasive lung surgery, the lesion should be explored first and the exact location of the lesion should be found before the corresponding lobectomy is performed. The location of the lesion can be determined by preoperative CT localization with a puncture needle or local injection of melanoma, or by clock localization, or by intraoperative ultrasound localization. Nodules located in the superficial surface of the lung with pleural indentation or nodules with more solid components and a harder texture are localized by visual or finger touch or instrumentation glide action. However, for some GGO with few solid components and similar texture to normal lung tissue, or with small and deep lesions, localization is difficult, and wedge pneumonectomy or lobectomy can only be performed according to the clock localization method. The scope of surgical resection. It is made according to the stage of lung cancer, the location of the tumor, the patient’s age, general condition, lung function and other comprehensive considerations. Generally, tumors located on the surface of the lung, T1N0M0 or those with advanced age, poor general condition and lung function can be considered for wedge lung resection or lung segmental resection, and tumors with GGO solid component ≤ 50% can be resected by lung segmental resection. Lobectomy is still the standard procedure for lung cancer surgery. A few central lung cancers located at the bronchial opening require thoracoscopic pulmonary sleeve or double sleeve resection, bronchial or pulmonary vascular reconstruction, and continuous suturing with two 4*0 prolene sutures followed by tightening and knotting, unlike interrupted suturing under direct vision. Surgical sequence. There is no fixed sequence of minimally invasive lobectomy, with easy and then difficult individualized treatment. Pulmonary veins are located anterior or inferior to the pulmonary hilum, superficially located and easily dissected, and therefore are treated first. The veins are treated first to prevent the possibility of hematogenous metastasis triggered by the operation. If the pulmonary fissure is complete and the pulmonary artery is easily dissected, the pulmonary artery is treated first before the bronchus. If the pulmonary fissure is incomplete, after severing the pulmonary veins, the right upper lobe of the lung is then treated for the apical anterior segmental arteries, and the left upper lobe of the lung is then treated for the apical and anterior segmental arteries, as these arteries are not in the interlobular fissure and are located superficially above the pulmonary hilum and are easy to dissect. After dealing with these vessels in the left and right upper lobes, the upper lobe bronchi can be dissected, the parabronchial lymph nodes are removed, the bronchi are fully freed, the Endo-GIA 60*4.8 mm is closed at 12.5 px from the upper lobe bronchial orifice, and cut off after the ventilation test is verified, and then the remaining pulmonary arteries and interlobular fissures are dealt with. In the middle lobe of the right lung and the lower lobe of the right and left lungs, after dealing with the pulmonary veins, the bronchi are then dealt with, followed by the pulmonary arteries, and finally the interlobular fissures. The unidirectional lobectomy uses the model of treating the easier first and then the more difficult. If there are lymph nodes that are more difficult to separate between the pulmonary artery and the bronchus, it is safer to first dissect and separate between the bronchus and the lymph nodes, cut the bronchus, then remove the lymph nodes, and finally deal with the pulmonary artery, even if the completely divided pulmonary artery is easily revealed. If the interlobar fissure is treated first and then the pulmonary artery is treated, the interlobar fissure is then dissected between the interlobar pulmonary vein branches, above the plane of the pulmonary artery, and then the interlobar fissure is dissected. In conclusion, making minimally invasive pulmonary surgery both safe and easy to perform is to start with the easy and then the difficult. Management and prevention of unforeseen circumstances. The common and most dangerous complication of minimally invasive lobectomy is intraoperative bleeding, mainly from the pulmonary artery. Once bleeding is encountered, first stop the bleeding by compression with instruments such as oval clamp or clamping the bleeding site with oval clamp, then expand the incision and stop the bleeding under direct vision after the retractor retracts. Dissect the proximal and distal ends of the vessels at the bleeding site first, or block the main trunk of the pulmonary artery, remove the oval clamp after clamping the proximal and distal ends without injury, find the bleeding point and suture to stop the bleeding, or close the bleeding point with a titanium clamp, or ligate the root and distal end of the bleeding vessel. A small amount of blood oozing from the pinhole of the vessel stump will stop on its own after a few minutes of compression with woolen gauze. The stump of the cut vessel should not be pulled and clamped, otherwise it will cause deformation of the suture staple and result in stump bleeding. Lymph node dissection, usually performed with a combination of ultrasonic knife and electric hook, and small bronchial arteries are closed and severed after removal of the lymph nodes to reduce postoperative bleeding. The length of both the stump of the vessel and the stump of the bronchus are controlled to about 5 mm during the operation. Too long will form a thrombus, which will dislodge and cause an embolism and produce a serious seizure, and too short will make it difficult to stop bleeding when bleeding occurs. Too long bronchial stumps can cause secretions to accumulate in the stump, causing infection and coughing. After the incomplete lung split is incised, the cut edge is closed with 3*0 prolene suture attached to prevent bleeding and air leakage from the cut edge, forming a small bronchopleural leak. The thicker bronchial arteries should be cut off after titanium clamp clamping or ligation. Because the bronchial artery comes directly from the aorta, the pressure is high and will not stop on its own once bleeding occurs. When closing the chest wall incision, the thoracoscope should carefully check whether there is bleeding from the incision and stop bleeding completely before closing the incision, such as placing a chest drainage tube with two holes at the top of the chest drainage tube, placed at the top of the chest cavity, and two more holes at 100px from the chest wall incision to the exit of the chest drainage tube, so that the exhaust and drainage effect is good and will not cause pleural effusion and pulmonary atelectasis.