The technique of minimal invasive surgery has successfully been introduced into the area of thoracic surgery. Surgery of the intrathoracic organs may now be performed without compromise of respiratory mechanics, thus allowing the operative treatment of an ever widening range of pathological conditions. An analysis of our experience (287 thoracoscopic interventions in the last three years) reveals that the diverse procedures performed on the pleura (pleurectomy and pleurodesis), on the lung (wedge resection, fistula closure and ligature of parenchymatous leaks) and on other defined anatomical structures such as the sympathetic nerves or the thoracic duct, are effective in the therapy of intrathoracic disease. The most important pathological conditions which may be treated by thoracoscopy are listed. The range of complications and their causes, which developed in 8% of all procedures, are discussed. The current limitations of this method are defined in the context of the situations where thoracoscopy was discontinued (9 times), a thoracotomy performed (17 times) or a further procedure became necessary (14 times). Current developments and innovations are summarized by a short review of the literature.