Pikunov M.Yu., Vishnevsky A.A., Golovteev V.V., Starkov Yu.G., Perepechin V.I. Moscow The advent of modern video technology and improved endoscopic instrumentation made it possible to perform many transthoracic interventions using videothoracoscopic techniques. Videothoracoscopic surgeries have been performed in the Thoracic Department of the A.V. Vishnevsky Institute of Surgery of the Russian Academy of Medical Sciences since 1995. One of the priority areas of this activity is the removal of small peripheral lung lesions using a gentle, minimally invasive technique. A total of 200 videothoracoscopic surgeries were performed in patients with small peripheral lung lesions. 107 had benign tumors (hamartochondromas), 58 had tuberculomas, 5 had metastases, 7 had post-inflammatory pneumofibrosis foci, 8 had foreign bodies, and 5 had other tumors. In 10 patients with peripheral lung lesions, peripheral cancer was confirmed after intraoperative histological examination. In all cases, a conversion to thoracotomy was performed, and the surgery was completed open, adhering to all oncological principles. Using a comprehensive set of modern methods for preoperative diagnostics of lung lesions allows for a clinical and radiological diagnosis with an accuracy of 84-91%. The final stage of diagnosing peripheral lung lesions occurs during video-assisted thoracoscopic surgery after an urgent histological examination of the obtained material. A clinical and morphological diagnosis was established in 100% of cases. Thus, video-assisted thoracoscopic surgery achieves a dual purpose—diagnostic and therapeutic. All peripheral lung lesions were removed radically. A significant limitation in the development of video-assisted thoracoendoscopic surgery is the difficulty of intraoperative topical diagnosis of peripheral lung lesions due to the inability to palpate them. The following methods were used to detect tumors: a) multiposition radiography and computed tomography (CT), b) preoperative CT-guided tumor marking, c) intraoperative direct visualization of the lung, d) instrumental "palpation" of the lung, d) intraoperative lung ultrasound. Preoperative tumor marking was performed with methylene blue under CT guidance in 49 patients. This method allows for the search for tumors in a specific area of ??the lung, which accelerates the process by 15-20 minutes. The intraoperative direct visualization method allows for the localization of only subpleural tumors or their superficial landmarks (adhesions, pleural retraction, fibrin deposits). In 60% of patients, the tumors were located intraparenchymatously and were not visualized. Instrumental "palpation" did not detect them. Intraoperative lung ultrasound was the most informative method for identifying these tumors. The study included 107 interventions. In 98% of cases, the location of the lung mass was identified or clarified, which was the primary objective of the study. Lung ultrasound during video-assisted thoracoscopic surgery is a highly informative method that enables precise diagnosis of lung masses, assessment of organ and tissue structure during surgery, and, acting as a kind of surgeon's hand, refinement of the surgical plan and design. A total of 127 marginal lung resections, 31 wedge (atypical) resections, and 42 hamartochondroma enucleations were performed. The use of linear endostaplers allows for the creation of a pulmonary suture with complete aero- and hemostasis. The advantages of minimally invasive surgery in patients with peripheral lung masses are now clear. Clear indications for such procedures, along with the use of a modern range of diagnostic instruments and surgical techniques, enable the reliable and rapid removal of peripheral lung masses with minimal complications and excellent cosmetic results.