Making a decision of conversation is always difficult, but should be done in a timely manner

Levi et al. introduced video-assisted thoracoscopic surgery (VATS) in 1990 (1). VATS has become an alternative technique, especially for benign diseases (2,3). After the accumulation of surgical experience for benign diseases, VATS technique has been gradually applied for lung cancer surgery. Roviaro et al. first reported the VATS lobectomy for lung cancer. Since then, many investigators have evaluated and reported the efficacy of VATS for lung cancer (4). VATS is considered to be superior to a thoracotomy in terms of perioperative pain and cosmesis. However, several issues needed to be confirmed, the most important of which are the adequacy of VATS for cancer operations and its safety.