We review our experience in video-assisted thoracoscopic surgery (VATS) on patients over 75 years of age from a single institution.From September 1992 to November 1995, 22 patients (13 males and 9 females with mean age of 78.1 years) underwent the following procedures: pleural biopsies with or without drainage and decortication (5), drainage of empyema (2), wedge lung biopsy (3), bullectomy and talc insufflation (1), major lung resections (5), mediastinal biopsy (1), pericardiectomy (3), and thymectomy (2). Pulmonary function tests of the entire group showed the mean forced expiratory volume in 1 s (FEV1) to be 1.46 1 (range 0.63-2.11) and forced vital capacity (FVC) to be 2.04 (range 0.98-3.55) 1.There was no mortality. Morbidity included prolonged chest drainage over 7 days in two patients (9.1%), one of whom was discharged with a drainage bag. Particularly of note was the lack of postoperative pulmonary complications.We conclude that VATS in the elderly population is safe. Age alone should not be a contraindication for major lung or mediastinal surgery.