Giant bullous emphysema often has serious dyspnea, and is difficult to manage. Bullectomy through thoracotomy for this disease carries a substantial morbidity and mortality. The aim of this report is to investigate the feasibility and key techniques of video-assisted thoracoscopic bullectomy for giant bullous emphysema. From December 1995 to October 1996, 6 patients with giant bullous emphysema underwent bullectomy by means of video-assisted thoracoscopy. Giant bullae occupied at least 50% of hemithorax, and 4 of which occupied more than 90%. According to Hugh-Jones dyspnea criteria: grade II in 3 cases, grade III in 2 and grade IV in 1, four bullectomies were done by video-assisted theracoscopy alone. One bullectomy and one left pneumonectomy were performed by combination of theracoscopy and a 8 cm thoracic incision. All procedures were accomplished successfully. The operating time ranged from 65 to 150 minutes. There was no blood transfusion and perioperative complications. Lung function was significantly improved in all patients after surgery (all better than grade II). Thoracoscopic bullectomy for giant bullous emphysema is a technically feasible and safety procedure, especially for group I and group II patients. However, there are still many problems to be resolved in thoracoscopy for group III and IV giant bullous emphysema.