Video-assisted thoracoscopic surgery (VATS) is an effective and less invasive modality for management of mediastinal disorders, but various complications can result from the procedure. This report describes a case of delayed rupture of the bronchus intermedius which occurred on postoperative day 1 after the patient underwent complete thoracoscopic removal of a mediastinal bronchogenic cyst (BC) with pericystic adhesions to the bronchus. The bronchial rupture was successfully treated by conventional surgical instruments through limited thoracotomy with video-assisted thoracoscopic guidance. In recognition of this possibility, VATS for a BC with adhesions should be carefully performed. Additionally, the role of VATS in bronchial repair is beneficial.