PURPOSE: The aim of this study was to evaluate the efficacy and safety of thoracoscopy in the treatment of solid thoracic tumors in children. METHODS: A retrospective, multicenter review of 139 thoracoscopies was performed. The procedures were either resection of pulmonary lesions or biopsy. Complications, histologic biopsy results, and outcomes were reviewed. RESULTS: One hundred thirty-nine procedures were performed in 134 children. There were 72 males and 62 females, with a mean age of 9.2 years (3 months to 17 years). The mean follow-up was 4.5 years. Thirty-eight primitive tumors were managed, 20 of which had a complete thorascopic resection, and nine biopsies were performed. In 9 additional cases, an open conversion was necessary. Among the 20 complete resections, 17 of the lesions were neurogenic tumors (i.e., neuroblastoma or ganglioneuroma). Three complications occurred: 2 chylothoraces and 1 with Horner syndrome. All three complications regressed. The mean follow-up was 3 years, and no recurrence has been noted. Fifty-three metastatic lesions were managed: 29 had a complete resection, 11 had a biopsy, and an open conversion was necessary in 13 cases. Among the complete resections, more than half were metastases from bone tumors. The mean follow-up was approximately 4 years and 5 pulmonary recurrences developed. Four deaths occurred, with 2 having had lung metastases. Forty-eight malignant hemopathies were managed; 9 biopsies for primitive tumors were performed. There were 36 secondary lesions, of which 5 were completely resected; 30 were biopsied and 1 required an open conversion. CONCLUSIONS: Thoracoscopy is a safe, effective approach for the evaluation and resection of solid lung tumors and for biopsy. Thoracoscopic resection of metastatic lesions is reasonable for nephroblastoma, but a thoracotomy is suggested for other metastases.