Background: Video-assisted thoracic surgery (VATS) exploration is a frequently performed surgical intervention in thoracic surgery in cases such as pleural biopsy, mediastinal and hilar lymphadenopathy biopsies, hemothorax and air leak control. In this study, 497 patients were reviewed and extended indications of VATS exploration were revealed. Methods: All of the patients with radiologically detected intrathoracic pathology between 2009-2019 were included in the study. Preoperative, intraoperative and postoperative findings were evaluated retrospectively. Results: The clinical indications for VATS exploration were pleural effusion, intrapulmonary mass, cystic lesion, mediastinal lymphadenopathy or mass that has been investigated with a pre-diagnosis of malignancy or developed secondary to previously known malignancy, prolonged air leakage and / or lung expansion problems, mediastinal mass, hemothorax, pleural thickening or pleural nodule, chest wall tumor, pericardial cyst or effusion, chylothorax, and intrathoracic cavitary lesion. All patients with these indications were managed mainly with VATS exploration. Conclusion: Evaluation of operability criteria, and subtype determination for targeted therapies in the diagnosed patient, definitive diagnosis can be made and over-treatments can be prevented due to the precise biopsies can be taken with VATS exploration. We recommend the VATS exploration as a key step for all intrathoracic pathologies.