Key Points

• Video-assisted thoracic surgery (VATS) is useful for undiagnosed exudative pleural effusions to rule out malignancy.
• VATS is very effective for empyema before the chronic fibrous phase, which occurs after 3-4 weeks.
• VATS wedge resection for peripheral nodules provides definitive diagnosis.
• VATS lobectomy appears safe and comparable to open lobectomy when done by experienced thoracic surgeons.
• Lung volume reduction study may be done by VATS or sternotomy with comparative long-term outcome results in regard to lung function, 6-minute walk, and oxygen requirements.
• VATS sympathectomy approaches 100% success for palmar hyperhidrosis.
• VATS pericardectomy may provide advantages over a subxiphoid approach when the cause is benign; for malignant sources, the subxiphoid route is typically preferred.