Video-assisted thoracic surgery (VATS) is now commonly used to treat malignant tumors of the lung. Generally, there are 2 styles of VATS: one uses only the view in a monitor and the other makes use of direct vision through an access port. Since both are minimally invasive, the difference is a matter of the surgeon's preference, and it is likely to have no effect on the patient. In all cases, we seek to minimize the destruction and deformation of the thoracic wall while maintaining the quality of the surgical procedure. We consider VATS to be a standard procedure. Many studies have compared the results of VATS and thoracotomy, but it is unlikely that thoracotomy will suddenly replace VATS. Usually, the standard surgical procedure changes gradually. If the surgeon encounters unexpected circumstances, he or she could change the surgical approach. We think that the border between thoracoscopic surgery and thoracotomy is blurred. Between 1998 and 2008, we operated on 395 patients with primary lung cancer. Of these, 207 cases with stage I underwent a lobectomy with lymph node dissection. There were no differences in survival, according to surgical approach. Although we have not always adopted VATS for advanced lung cancer, we are using a similar approach to perform any kind of bronchoplasty, pneumonectomy, or extensive resection for lung cancer more effectively. It is a step forward to be able to perform surgery using advanced techniques but, ultimately, it is not the technique that is of primary importance, it is the benefit the patient receives.