Abstract Background We sought to establish the feasibility and efficacy of video-assisted thoracoscopic (VATS) lobectomy in treating lung cancer in a veteran population. Methods We retrospectively analyzed preoperative, intraoperative, and postoperative parameters in 46 VATS versus 45 open lobectomy patients at a single center. Results The 2 groups were similar in preoperative and intraoperative variables. Although surgical mortality was not significantly different after lobectomy performed with VATS (0 of 46) compared with open lobectomy (2 of 45, 4%; P = .2), there were fewer complications in VATS patients (14 of 46, 30%) than their open counterparts (26 of 45, 58%; P = .009). VATS patients also had a shorter chest tube duration and length of stay. In multivariate analysis, VATS was associated independently with a reduced risk of complications (odds ratio, .359; P = .04). Conclusions VATS lobectomy in a veteran population is feasible and safe and may lead to better perioperative outcomes than open thoracotomy without compromising oncologic principles.