[Thoracoscopic surgery].

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.