The application of video-assisted thoracic surgery (VATS) for major lung resection is controversial. We review our combined experience from three centers in Asia. From June 1993 through June 1997, 214 patients underwent VATS major resections (2 segmentectomies, 203 lobectomies, 6 bilobectomies, 3 pneumonectomies), mostly for primary malignancy. Stringent selection criteria were used to choose patients for this approach. We prefer a technique of not spreading ribs, using conventional thoracic instrument for dissection and routine use of wound protector for specimen retrieval. There was one postoperative surgical death and 47 non-fatal complications, which compare favorably with published series on open technique. Of the primary lung cancer patients, 93% are still alive after a mean follow-up of 26 months. We conclude that VATS major lung resection is technically feasible in selected patients and associated with favorable intermediate-term results.