A 74-year-old male patient with a 4 cm diameter mass in his upper right lung was diagnosed with cancer by puncture. The examination also revealed that the patient had a 0.6 cm mass in each of the left and right lower lungs, however, the diameter was too small to allow localization of the puncture and the benign and malignant nature could not be confirmed. The patient and his family were so anxious that they came to Jiangsu Provincial People’s Hospital for thoracic and cardiac surgery. Through careful analysis, we concluded that from the diagnostic point of view, the nature of the left lower lung mass needed to be clarified as soon as possible, and the treatment direction varied greatly depending on the benign and malignant nature. From the surgical point of view, because the traditional open-heart surgery is more traumatic, almost no one can afford to operate on both left and right sides at the same time, let alone an old man who is over 70 years old. To address the above situation, we decided to perform thoracoscopic surgery for the patient to achieve both diagnosis and treatment with the help of minimally invasive technology. During the operation, two “keyholes” of 1 to 2 cm in diameter were made on the left and right sides of the patient’s chest, and with the help of sophisticated instruments and skillful operation techniques, the masses were removed from the left and right lower lungs and quickly sent to the pathology department, and the results came in half an hour later. A 4 cm incision was immediately made in the right chest and a thoracoscopic radical resection of right upper lung cancer was performed. With the help of thoracoscopic technology, a clear diagnosis was achieved and the patient’s pain was solved under minimally invasive conditions. Due to the minimal trauma of the surgery, the patient recovered quickly and was able to walk out of bed the next day. Another female patient in her 50s was also more typical. She had a 0.8 cm diameter mass in her right upper lung with “hairy glass” changes on CT, which remained the same size for several months, but again, the diagnosis could not be confirmed because puncture was not possible. The surgeon performed a thoracoscopic surgery and a rapid intraoperative pathology, which revealed a “fine bronchoalveolar cell carcinoma”, and immediately performed a right upper lung lobectomy. Due to early detection and timely and thorough surgery, the patient’s prognosis was almost indistinguishable from that of benign disease and did not require special treatment such as chemotherapy. It is understood that lung cancer is one of the malignant tumors that seriously endanger human health, and the cancer with the highest incidence and mortality rate in the world at present. The current treatment methods for lung cancer include surgery, chemotherapy, radiotherapy, biological therapy and traditional Chinese medicine, etc. However, the overall efficacy is poor. The 5-year survival rate after treatment for mid- to late-stage lung cancer is 1%-30%, while the 5-year survival rate after surgery for early-stage lung cancer (stage I) is significantly higher, reaching 57%-67%. Therefore, early detection of lung cancer is crucial, and the importance of timely detection and treatment of small lung masses is even more self-evident. X-ray chest film and CT examination of small lung masses are generally unable to express their symptoms and determine their benign or malignant nature. Many of the early cases encountered in clinical practice are found during physical examinations or inadvertently during visits for other diseases, and these patients can be fortunate enough to have access to early surgery. Of course, not all lung masses are cancer, but they can also be inflammatory, tuberculosis and other diseases. How to diagnose a small lung mass as small as a green bean or soybean is really a problem in the medical field. It is difficult to locate a small mass by puncture, and it is impossible to confirm the diagnosis. In the past, regular review and experimental drug treatment were adopted for months or years, and the best time for treatment was missed for those cancer patients. Notably, these problems can be solved with the promotion of thoracoscopic technology, which has obvious advantages. Under thoracoscopy, diagnosis and treatment can be performed simultaneously, with small incision surgery to remove the tumor and intraoperative delivery of rapid pathology to end the surgery if the result is benign, and immediate radical lung cancer surgery if it is malignant. Thoracoscopic surgery is significantly smaller than traditional surgical incisions, requiring only a few incisions of about 1 to 4 cm, and more importantly, it causes statistically minimal damage to heart, lung, liver, kidney function and the nervous and motor systems. Thoracoscopic technology has been introduced to China since the early 1990s, and after more than ten years of application and research, it has become more standardized and mature. Jiangsu Provincial People’s Hospital carried out thoracoscopic surgery in 1997 and lobectomy in 2006, and has so far completed more than 400 cases of various types of surgery, including more than 60 lobectomies, 10 radical esophageal cancer cases, and others including lung wedge resection, pleural biopsy, lung biopsy, pulmonary alveoli, mediastinal tumor, myasthenia gravis, hand sweating, funnel chest, abscess chest, traumatic hemopneumothorax, diaphragmatic hernia, etc.