Background <p>Congenital thoracic cysts (CTCs) are rare developmental anomalies of the foregut, encompassing bronchogenic, oesophageal duplication, and neuroenteric cysts. Their presentation in childhood ranges from asymptomatic incidental findings to severe respiratory or feeding compromise. While surgical excision is the standard of care, the application of Video-Assisted Thoracoscopic Surgery (VATS) requires careful evaluation in the paediatric population.</p> Methods <p>We conducted a retrospective, descriptive case series of six paediatric patients (aged 0–7&#xa0;years) who underwent surgical excision of a CTC between 2017 and 2025 at Addenbrookes Hospital (<i>N</i> = 6). Data on demographics, presentation, imaging, operative approach (VATS vs. Open), and postoperative outcomes were analysed.</p> Results <p>The cohort included three oesophageal duplication cysts, two bronchogenic cysts, and one complex neuroenteric cyst. Two cases were diagnosed antenatally, and two were incidental. Symptomatic presentations included stridor with feeding difficulties (<i>n</i> = 1) and severe respiratory compromise (<i>n</i> = 1). VATS was utilised in five of the six cases (83.3%). The single complex neuroenteric cyst required open thoracotomy due to spinal extension identified on preoperative imaging.</p> <p>Postoperative courses were uncomplicated in this series, with a mean chest drain duration of 36&#xa0;h and an average hospital stay of 3&#xa0;days.</p> Conclusion <p>In this limited series, VATS appeared to be a feasible approach for bronchogenic and oesophageal duplication cysts without spinal connection.</p> <p>Cross-sectional imaging, specifically MRI, was critical in identifying spinal extension which necessitated an open approach. These observations are descriptive and highlight the importance of preoperative planning; however, larger cohorts are required to draw definitive conclusions regarding comparative safety or efficacy. </p>