Since the early 1990s the video-assisted thoracic surgery (VATS) has been used for lobectomy, which is the standard procedure performed for early stage lung cancer. Recent developments in video systems and improvements in endoscopic instruments have allowed VATS to become established as a useful minimally invasive surgery for intra-thoracic disease. The progress seen in VATS lobectomy for lung cancer has been the subject of many recent reports that have tried to compare the current status of VATS lobectomy to conventional thoracotomy lobectomy by focusing on the indications, surgical techniques, prognosis, postoperative pain, and morbidity of the procedures. The results of the present review substantiate the impression that VATS lobectomy for stage I lung cancer patients has matured to become an established, safe and reliable surgical technique, with a long term survival at least the same as that of a conventional lobectomy. Furthermore, VATS lobectomy offers an advantage with respect to the patient's postoperative quality of life.