Thoracoscopy has been a valuable modality for the diagnosis and treatment of pleural-based disease for almost 100 years. With the development of video technology and improved instrumentation, video-assisted thoracoscopy is the procedure of choice for effusions of unknown origin, pleural mass biopsy, and free-flowing empyema drainage when conventional techniques fail. Reported success rates have been very good for diagnosis and treatment of both benign and malignant disease, and the morbidity is low.