Video-assisted thoracic surgery (VATS) is gaining popularity as a technique for performing lobectomy in lung cancer. However its advantages over a limited or muscle-spearing thoracotomy for lung cancer surgery are still a matter of controversy. There is no obvious advantage in cancer prognosis, invasiveness and postoperative quality of life of VATS comparing with minimal thoracotomy. Recent data illustrate the need for critical evaluation of VATS before the procedure is accepted as a superior approach for thoracotomy, based on unproved advantages. With the wide use of lung cancer CT screening systems, it can be anticipated that early lung cancer cases will increase in the near future. Consequently, the establishment of a surgical procedure with radicality and less invasiveness will be strongly demanded for lung cancer.