Video-assisted thoracoscopic surgery (VATS) has been a mainstay in surgical interventions for an early staged lung cancer over a decade. VATS procedures are nowadays categorized into 2 groups. One is a modified open procedures through a mini-thoracotomy with customization of conventional instruments. The other is a port-access procedure with use of newly developed instruments for endoscopic surgery. The optimal device adapting for individual surgical manipulations should be selected to make a VATS procedure safer and more feasible. The sample extraction using a bag is a most important step when VATS is completed, because the rupture of bag can result in cancer cell contamination. More useful devices adapting either for mini-thoracotomy VATS or for port-access VATS, will be developed with advancement of medical technology.