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The newest surgical approach to pulmonary metastasectomy is by video-assisted thoracoscopic surgery (VATS). This minimally invasive approach provides excellent exposure of the lung surface, and by palpation nodules below the surface. It reduces surgical trauma, minimizes postoperative pain, provides earlier patient mobilization, and decreases hospital length of stay. Pulmonary metastases are often small nodules located in the periphery of the lung, well suited for wedge resection by stapler and the VATS approach when they are limited in number.