Since 1994, we have performed video-assisted thoracoscopic surgery in order to treat thoracic trauma. In general, emergency surgery is performed for trauma injuries incurred by knives. Between 1994 and 2005, we performed thoracoscopic surgery on eighteen cases of thoracic stab wounds. Among these eighteen cases, two were characterized by wounds to the internal thoracic artery, and they had to be switched over to open thoracotomy due to excessive bleeding. In conclusion, open thoracotomy should be performed in cases in which the patient is in a state of shock due to severe intrathoracic bleeding; however, in cases in which the vital signs are stable, thoracoscopic surgery may be carried out to stop intrathoracic bleeding, to repair the lung injury by suturing, as well as by performing a partial resection of the lung.