In many instances surgical intervention in the chest has been replaced by the minimally invasive thoracoscopic or VATS approach. With such a technique there are disadvantages, complications and contraindications that develop or exist. Disadvantages include the loss of tactile sensation and the cost of the procedural equipment. Absolute contraindications include a fused lung, markedly unstable patient, shock or cardiac arrest, and an individual unable to tolerate partial or complete unilateral collapse of the lung. Lesser contraindications include the patient with bleeding tendencies or under anticoagulant therapy. The few major complications we have seen include prolonged air leak, pulmonary atelectasis and respiratory failure, the "down" lung syndrome or retained secretions. Technical complications including inability to locate the lesion because of its small size, penetration of the lung or inadequate resection of a tumor with subsequent seeding of the tract through the pleural and chest wall have been reported. Major bleeding has not occurred in our institution. Mortality has been seen only in the preterminal malignancy patient.