Video-assisted thoracoscopic surgery (VATS) is a newly developed technique, the advantages of which mainly benefit the patient. Its feasibility and indications have been described widely, but to the best of our knowledge no report of the successful VATS management of a large mediastinal teratoma has ever been documented. When such a tumor is encountered, conversion to thoracotomy would usually be carried out. We report our experience of removing a large teratoma, 8 x 7 x 11 cm in size, from the anterior mediastinum, employing VATS and utilizing only four small intercostal incisions without spreading the ribs.