We reviewed 48 cases of pulmonary nodules in which video-assisted thoracoscopic surgery was done at Jichi Medical School Hospital from 1992 through 1995. The pulmonary nodules comprised 14 malignant tumors (9 lung cancers and 5 pulmonary metastases), 10 benign tumors (7 hamartomas, 2 localized mesotheliomas and 1 tumorlet), 19 granulomas (8 inactive infectious tumors, 7 active infectious tumors, and 4 granulomas as sequelae of other diseases), 4 intrapulmonary lymph nodes, and 1 pulmonary cyst. Conventional operations for lung cancer were done in 7 cases, and 6 were found to be ST-I. Tumor resection by video-assisted thoracoscopic surgery allowed diagnosis of rare diseases and treatment of benign lung tumors and of lung metastases. We conclude this procedure is very useful for diagnosis and treatment of indeterminate pulmonary nodules.