The authors describe their experience in performing Videothoracoscopy as the first step of the operation in patients affected by lung cancer: they refer to this procedure as Videothoracoscopic Operative Staging (VOS). In 286 patients, already proposed for curative surgical resection on the basis of conventional staging, VOS was carried out in order to reach a conclusive judgement of resectability. VOS discovered unsuspected causes of inoperability in 17 patients (5.7%), while 269 patients underwent surgical operation but in 9 of them this consisted in an exploratory thoracotomy (ET). Furthermore, VOS allowed us to assess the operability of 11 patients in whom preoperative computed tomography (CT) had suggested unresectability but without providing a definitive judgement. Based on their experience the Authors conclude that VOS should be performed in every patient affected by lung cancer in order to obtain a more detailed staging and to reduce to a minimum the number of ETs. By using VOS it was possible to decrease the rate of exploratory thoracotomies to less than 4%.