understanding of pulmonary anatomy to allow for strategically placed incisions (usually 3–5 incisions total). The main advantages of VATS over thoracotomy are that major muscles of the chest wall are not divided and rib spreaders that can lead to rib fractures or costovertebral joint pain are not used. This results in a hospital length of stay after VATS lobectomy generally reported to range from 3–5 days, or roughly half that for lobectomy via thoracotomy. Candidates Not all patients are candidates for VATS lobectomy. The classic indication for a VATS approach to lobectomy is early stage lung cancer in which the primary tumor is 3 cm or less in diameter and located toward the periphery of the lung parenchyma. Tumors that are located close to the major blood vessels or airway where these enter the lung or larger tumors associated with tumor spread to lymph nodes in the central regions of the lung may require the enhanced tactile input afforded by thoracotomy to make sure the tumors are resected with a negative margin, i.e. that the tumor is surrounded completely by a margin of non-cancerous tissue, and that arteries and airways to portions of the lung that are not being removed are preserved intact. In addition, patients who have had pre-operative chemotherapy or radiation for lung cancer or previous chest surgeries may not be candidates for VATS due to scarring around the major blood vessels that makes dissection via VATS difficult. But recent evidence suggests that thoracoscopic lobectomy is a feasible approach for selected patients undergoing resection after induction therapy, and is associated with shorter hospital stay and chest tube duration. Cases in which a lung tumor invades the chest wall and an en bloc resection of ribs must be performed to achieve negative resection margins generally are felt to abrogate the value of VATS. Also pneumonectomy by VATS is a safe and feasible treatment for both benign and malignant lung diseases that induces acceptable damage and has lower morbidity. Published benefits Because of the lesser chest wall trauma of VATS compared to thoracotomy, elderly patients have been shown to tolerate lobectomy by VATS better than via thoracotomy. Patients who require chemotherapy after surgery have been shown to be more likely to succeed in completing the prescribed course of chemotherapy after VATS lobectomy compared to lobectomy via thoracotomy. Along with the lesser chest wall trauma and improved pulmonary mechanics, a lesser