Thoracoscopy is used as an adjunct to traditional diagnostic thoracoscopy. Because of advances in endoscopic surgical equipment and anesthetic technology, surgical treatment via thoracoscopic is now possible. Between June and November 1995, seven male and two female patients underwent thoracoscopic procedures under general anesthesia with a double-lumen endotracheal tube in Ratchaburi Hospital. The procedures for diagnostic purposes included 2 diffuse lung diseases, 1 pleural metastatic disease; and the procedures for therapeutic purposes included 1 case of massive pleural effusion, 2 of clot haemothorax, 2 empyema thoracis, and 1 solitary pulmonary nodule. The thoracoscopic procedures included 2 lung biopsies, 1 pleural biopsy, 2 decortication with removal of blood clots and 2 decortication of empyema, and 1 pulmonary wedge resection. There was no mortality associated with VATS. We believe that the patients have benefited from VATS in reducing post-operative pain, rapid recovery, and decreased scarring of the chest wall. VATS is a minimally invasive surgical technique causing a low morbidity rate and attaining a high diagnostic accuracy.