By 2002, we had attempted video-assisted thoracoscopic surgery (VATS) lobectomy or segmentectomy for 140 primary lung cancer cases. Four cases (2.9%) were converted to standard posterolateral thoracotomy for oncologic reasons and aortic injury, and 7 cases (5%) were converted to minithoracotomy with a 10 cm incision due to almost injuring the vascular system. Average blood loss in these cases was 379 ml, and there was no blood transfusion required. Seven of these 11 cases had true pleural symphysis in the thoracic cavity. The remaining 129 cases, consisted of 93 lobectomies and 34 segmentectomies, performed with a minithoracotomy of 5 cm using 2 ports. Average surgical duration was 227 minutes, and blood loss was 100 ml. Postoperative complication occurred in 15 patients (11.6%). Major complications included 1 broncho-pleural fistula, 1 pulmonary infarction, 1 cerebral infarction and 1 respiratory failure needed for mechanical ventilation. However, there were no hospital deaths. The mean postoperative hospital stay was 12 days. We recommend that surgeons should pay attention to hilar dissection, particularly in the presences of adhesion and carefully judge whether to convert to thoracotomy at the time of hemorrhage. The VATS procedure has a low mortality and morbidity for lung cancer, but particulaly in high risk patients, requires care and management the same as an open thoracotomy.