Video-assisted thoracic surgery (VATS) has been used in thoracic trauma for treatment of retained hemothorax, persistent pneumothorax, the diagnosis of diaphragmatic injuries after penetrating trauma, posttraumatic empyema, management of ongoing bleeding, retrieval of foreign bodies, and for traumatic chylothoraces. In some instances VATS has proved more effective than conservative treatment or chest tube placement. Thoracoscopy has proved to have a high degree of sensitivity and specificity in detecting diaphragmatic injuries. The main contraindication to VATS in trauma is patients who require emergency treatment because of hemodynamic instability; in these patients a thoracotomy or sternotomy should be used.