One hundred fifty video-assisted thoracic surgery (VATS) endoscopic hilar dissection lobectomy procedures are presented. Median blood loss was 65 mL and correlated with operative time (P < .0001) which averaged 144 minutes. Conversion to open thoracotomy was required in a further 20 patients (11.8%). One VATS patient (0.67%) died at 4 days from a catastrophic pulmonary embolus and 2 patients died within 30 days of surgery from pulmonary embolism and adrenal failure (overall 30-day mortality, 2%). Serious complications occurred in 3 cases: bronchopleural fistula (1) and requirement for ventilation (2). Air leakage (>4 days) occurred in 17 patients, correlated (P < .0003) with the presence of either adhesions or fissural fusion (11.3%), and resulted in prolonged hospitalization compared with patients without air leakage (11.1 vs 6.7 days; P < .0004). Open thoracotomy patients required 42% more morphine (P < .001) and 25% more nerve blocks than VATS patients (P < .001) who were 33% more likely to sleep following surgery (P < 0.01). Follow-up of 97 patients with non-small cell lung cancer (2,634 months total: mean 27) revealed 14 recurrences: 10 systemic and 4 (28.6%) within the thorax. No port site or pleural recurrences occurred. Stage analysis showed survival free of lung cancer-related death of 94% at 36 months for Stage I, 57% for Stage II, and 25% for Stage III.