Over the past two to three years video-assisted thoracic surgery has opened up new possibilities in diagnostic and therapeutic procedures. It is viewed as a sparing and quick alternative to thoracotomy and open operation for a number of indications including the treatment of pneumothorax, obtaining biopsies of undiagnosed diffuse or nodulary lung disease, as well as extirpation of peripheral pulmonary lesions. In oncological thoracic surgery it still remains to be verified whether the criteria of radicality are fulfilled by this new technique. Extipation of circumscribed, extrapulmonary benign tumours and cysts within the thoracic cavity will soon be routine procedures. The advantages lie in the minimally traumatizing surgical technique; as a result of avoiding thoracotomy postoperative pulmonary function is less restricted, there is less pain, earlier mobilization is possible and the period of hospitalization is reduced. In the majority of procedures the operative time is reduced as compared with open surgery. Our experiences in this field with 370 patients are briefly reported. Disadvantages are the loss of the possibility to palpate the lung and the thoracic cavity. The costs of employing this technique is discussed. Video-assisted thoracic surgery has a promising future; it is estimated that 20% to 30% of all thoracic interventions will be performed by this technique.