In recent times minimally invasive surgery has secured a firm place among the therapeutic options in thoracic surgery. The experience and results gained from video-assisted surgery on 109 patients between January 1, 1992 and July 31, 1993 are critically discussed. The procedure could be completed thoracoscopically on 94 of them. A change of method was necessary nine times for technical reasons and six times for oncological reasons (two times due to metastasis, four times due to bronchial carcinoma). A total of 154 individual operations were conducted. Sixty-three patients with recurrent spontaneous pneumothorax were successfully treated. The relapse rate was 1.5%. With the exception of three rethoracotomies (one due to postoperative hemorrhaging and two to persistent fistula) no significant complications occurred. Further indications included capsulated pleural empyema (n = 1), persistent hematothorax (n = 2), pleurectomy for malignant pleural effusion (n = 2), pleural tumors (n = 3), pulmonary parenchyma (n = 2), interstitial lung diseases (n = 3), bullous emphysema (n = 2), peripheral lung nodules (n = 18), mediastinal tumors (n = 8), and sympathectomy (n = 2). The advantages of video-assisted thoracoscopic surgery for patients include cosmetic considerations, low pain, earlier postoperative mobilization, and for some indications, a shorter operation period. The significant disadvantages for the surgeon are the loss of binocular vision as well as the impossibility of intraoperative palpation.