Thoracoscopy has been found useful for both the diagnosis and treatment of anterior mediastinal disorders. We have reserved it for use during thymectomy in the management of new-onset myasthenia gravis and for the resection of benign thymic, pericardial, and bronchogenic cysts. The application of thoracoscopic techniques in the anterior mediastinum should be approached conservatively. At this time, we believe it should be limited to diagnostic procedures requiring adequate biopsy and to therapeutic resections in which the extent of the resection is assured and therapeutic efficacy is maintained. We await further advances in both the instrumentation and technique before we are willing to undertake the performance of more radical resections using thoracoscopy. The efficacy of thoracoscopic thymectomy in the setting of myasthenia gravis awaits confirmation by larger clinical trials with adequate follow-up.