Abstract: To evaluate the effect of videossisted thoracoscope(VATS)in the treatment of empyema complicated with. ardiac or respiratory insulficiency. Methods: VATS was performed in all 22 cases. In the course of operation pus liquid clot as well asnecrotic tissues were clearedand encapsulated effusion on the thoracic cavity was strip ed to make the compressed lung fully expandResults:All of the 22 cases were recovered well with no death in the perioperative period. The operation time was between 35-63 minutes,and postoperative hospitalstay time was between 8-18 days. No recurrence of empyema hap ened. Conclusions:VATS has provedto he highly effectiveand is especially suitable for the patients who are weakly of cardiac or respiratory function.