Success in pneumonectomy, or any pulmonary surgery, depended upon learning the principles of positive pressure ventilation with endotracheal intubation, management of the pleural space, and confirming the advantage of anatomic dissection in individual ligation of hilar structures. The earliest successful pneumonectomies were performed for suppurative disease, but eventually became the procedure of choice for treatment of lung cancer until it became known that lobectomies would result in the same cure rate but with a decreased complication rate. At the present time, pneumonectomy is reserved for patients whose cancers require complete pneumonectomy for cure and for selected suppurative problems. Accepted techniques for conventional, intrapericardial and extrapleural pneumonectomies are described along with indications for the particular procedures.