Video-assisted thoracoscopic surgery (VATS) is a surgical operation involving thoracoscopy, usually performed by a thoracic surgeon using general or local/regional anaesthesia with additional sedation as necessary. It has historically also been referred to as pleuroscopy. A wide variety of diagnostic and theraputic procedures may be performed with this technique which has become very popular and increasingly so since the early 1990's. Prior to this time limited diagnostic procedures were done using variations on the cystoscope since 1910. Advances in direct optical visualization were quickly surpassed when video cameras were attached to the endoscopes. The advent of endoscopic stapling was also a major advance so that complicated procedures such as pulmonary lobectomy could be performed safely.