OBJECTIVE Empyema thoracis is a frequent clinical problem and share in common a considerable potential for death and morbidity. Video-assisted thoracoscopic surgery [VATS] debridement or decortication become popular and increase the available treatment options. The authors aim is to determine the efficacy and outcome of VATS for management of empyema thoracis in adult patients. METHODS A retrospective study of all adult patient treated for empyema between June 2009 to Feb 2011 at Thammasat Hospital was conducted. Recorded data included demographic information, clinical presentation, laboratory data, microbiological data, operative details, postoperative course, follow-up data and complications. RESULTS A total of 23 patients [5 women, 18 men] underwent VATS debridement and decorication for treatment of empyema thoracis. Their mean age was 57 [35-90] years. 17 [74%] patients received preoperative drainage [percutaneous catheter drainage or tube thoracostomy] and mean duration of preoperative drainage was 7.6 [3-26] days. 8 [35%] patients had stage II empyema and underwent VATS debridement while 15 [74%] patients had stage III empyema underwent VATS decortication. Median postoperative hospital stay was 12.6 [7-48] days. Median time for postoperative intercostals drainage was 5 [3-30] days. Median follow-up time was 5 [1-20] months. Conversion rate to open thoracotomy for stage II empyema was only 13%. There were 3 postoperative complications [13%]: wound infection [n = 1], persistent space [n = 1] and recurrent infection [n = 1]. There was no intraoperative death and 2 [8%] perioperative death [< 30 days] which were mostly unrelated to surgery. Of the 23 patients, 20 patients [87%] achieved satisfactory results with treatment. CONCLUSIONS VATS debridement and decortication is safe and effective treatment in the management of stage II and stage III empyema thoracis.