Video assisted thoracoscopy is now a well established technique in the armamentarium of the thoracic surgeon. Jacobaeus is credited with the technique of thoracoscopy and the first clinical application dates from 1913. He performed adhesiolysis to enhance pneumothorax therapy of tuberculosis via a cystoscope introduced into the pleural cavity. Before the 1990s thoracoscopic surgery was restricted to biopsy procedures, management of pneumothorax, empyema irrigation, sympathetic chain ablation, and removal of intrathoracic foreign bodies. The introduction of video imaging technology and the wider availability of stapling devices facilitated an increasingly wider use of thoracoscopy for diagnostic and therapeutic procedures. Video assisted thoracoscopic surgery (VATS) is principally employed in the management of pulmonary, mediastinal, and pleural pathology. However, the technique is not performed by thoracic and gastrointestinal surgeons only. VATS is now becoming a useful adjunct in specialised orthopaedic and neurosurgical units for minimally invasive approaches to the spine; also, many of the procedures performed in adults are now described in the paediatric population too. “Medical” thoracoscopy (as opposed to video assisted “surgical” thoracoscopy) is used exclusively for diagnostic purposes and has the advantage that it can be carried out under local anaesthesia or conscious sedation in an endoscopy suite.1 These latter specialised uses are not further considered below. The procedure is performed under general anaesthesia with the patient in a lateral decubitus position. Anaesthetic management is not different from the open procedures. Single lung ventilation with collapse of the ipsilateral lung is necessary. Carbon dioxide insufflation is very rarely required. A set of surgical instruments should be available on stand-by in case it is needed to convert to thoracotomy. For minor procedures three 1 cm incisions are used for the corresponding “ports”, thus allowing triangulation of the instruments: the camera is usually placed in the central port and the other …