Video-assisted Thoracoscopic Surgery (VATS), after over 50 years of silent interregnum, is experiencing a resurgence early in the twenty-first century. This is to the extent that VATS is slowly replacing traditional open procedures, hastened by technological advances and changes driven by modernity. These technological feats are mostly due to improvements in optics and instrumentation suited to operating in closed and narrow spaces. There has also been an improvement in workplace ergonomics. VATS can be deployed for both diagnostic and therapeutic purposes. Ideally, VATS practitioners should first be knowledgeable and skilled in the open procedures to tackle the technical differences in access, instrumentation, exposure, and risk of conversion. The benefits of VATS include reduced tissue damage, reduced post-operative pain, earlier recovery, shorter hospital stays, and cosmesis. These eventually lead to reduced costs for the patient. However, the steep learning curve; and, the initial costs of specialized instrumentations and hardware for VATS are major limitations. These limitations must be carefully considered to improve the practice and efficiency of VATS.