Objective To evaluate the feasibility of video-assisted minimal access surgery for lobectomy and pneumonectomy. Methods Under general anesthesia, via a video-assisted minimal access approach, anatomical lobectomy or pneumonectomy was performed through a 6- to 8-cm incision. A total of 42 patients, including 33 patients with lung cancer and 9 with benign tumor, received lobectomy (39 cases) or pneumonectomy (3 cases), which were performed under a video vision and a direct vision through the small incision. Results The average operation time was 2.5 h (1.5-4.5 h),and average blood loss was 200 ml (100-500 ml). In one patient, the incision was extended to a length of 12 cm because of tight adhesion between the tumor and the arch of azygos vein. Traditional open surgery was performed on one patient owning to the injury of the pulmonary artery trunk, which was due to the tight adhesion between the lung cancer at the left upper lobe and the pulmonary artery. Eight days after lobectomy, a 72-year-old patient with lung cancer died of respiratory failure caused by infection of the lungs. No operation-related complications occurred in the other 41 patients during a 6- to 47-month follow-up (mean, 18). Among the 32 patients with lung cancer, who were followed up for 8-47 months, 3 died of liver and bilateral lungs metastasis 8, 11, or 17 months after the opearation. Conclusion Video-assisted minimal access surgery is feasible for lobectomy and pneumonectomy.