Between November 1992 and October 1996, 20 patients with malignant pleural effusions were submitted to VATS under general anesthesia. The overall positive histological diagnoses were obtained through VATS (20/20). The malignant pleural mesothelioma in 8 cases and metastatic cancers in 12 cases were histopathologically confirmed. Talc pleurodesis was performed for all the cases, and 18 patients gained lasting pleurodesis and the other 2 patients did not. The failure of pleurodesis was due to that the lung could not reexpand to come into contact with the chest wall. Postoperative complications included transient fever and slight asthma in 2 cases, and the symptoms were relieved obviously after some simple therapy to symptom. In conclusion, VATS has provided a high positive diagnosis of patients with malignant pleural effusions not diagnosed by conventional methods and good results in pleurodesis, but some operating skills must be emphasized.