Videothoracoscopic and Videoassisted thoracic surgery makes diagnostic and therapeutic operation in the pleural cavity possible with minimal injury of the thoracic wall. The basic prerequisite is a free pleural cavity and selective pulmonary ventilation. VTS is a great asset in pulmonary biopsy, final treatment of a spontaneous pneumothorax, surgery of the thoracic sympathetic nerve and splanchnic nerves. VATS makes even such operations as lobectomy or pneumonectomy possible. According to the authors experience and views of the European Society of Thoracic Surgeons pulmonary carcinoma should be however operated by classical thoracotomy. The authors discuss the problem of indications and analyze operations implemented at the Third Surgical Clinic in Prague during the last three years.