Thanks to the recent improvements in video-assisted thoracoscopic techniques (VATS) and anesthetic procedures, a great deal of complex lung resections can be performed avoiding open surgery. The experience gained through VATS techniques, enhancement of the surgical instruments, improvement of high definition cameras and avoidance of intubated general anesthesia have been the greatest advances to minimize the trauma to the patient. Uniportal VATS for major resections has become a revolution in the treatment of lung pathologies since initially described 4 years ago. The huge number of surgical videos posted on specialized websites, live surgery events and experimental courses has contributed to the rapid learning of uniportal major thoracoscopic surgery during the last years. The future of the thoracic surgery is based on evolution of surgical procedures and anesthetic techniques to try to reduce the trauma to the patient. Further development of new technologies probably will focus on sealing devices for all vessels and fissure, refined staplers and instruments, improvements in 3D systems or wireless cameras, and robotic surgery. As thoracoscopic techniques continue to evolve exponentially, we can see the emergence of new approaches in the anesthetical and the perioperative management of these patients. Advances in anesthesia include lobectomies performed without the employment of general anesthesia, through maintaining spontaneous ventilation, and with minimally sedated patients. Uniportal VATS resections under spontaneous ventilation probably represent the least invasive approach to operate lung cancer.