Thoracoscopic apparatus is essential in present general thoracic surgery. Historically, the first description of diagnostic use of thoracoscopy traces back to 1910 when Jacobaeus inspected thoracic cavity with
cystoscope. In Japan, Kimoto treated lung
tuberculosis by thoracic ablation with
thoracoscope in 1944. Thereafter thoracoscopic procedure did not spread until 1990's when
laparoscopic cholecystectomy had rapidly popularized in Japan. After 1992 many reports about thoracoscopic surgery or video-assisted thoracic surgery (VATS) were published. In the early years VATS was done only for
spontaneous pneumothorax, and then indication of VATS had been gradually extended for
lung cancer, mediastinal
tumor and other
thoracic diseases. Nowadays 40% of
lung cancer operations are done by VATS in Japan. A thoracoscopic surgery is minimal invasive procedure in operations of
thoracic diseases, but should not be mixed with a limited operation of the
thoracic diseases. It is necessary to understand that these are different meanings. In VATS the technical procedures are different from the conventional general
thoracic surgical procedures and operators have to take special trainings of VATS procedure. But at present we do not have effective training systems of VATS for beginner surgeons. Various training method such as training box, animal laboratory, virtual reality system are effective respectively therefore an accurate training system should be made as soon as possible. Operators should keep in mind that the procedure of VATS or standard
thoracotomy operation is not a question and that the most important is to perform a smooth operation in adequate time for patients ease.