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OBJECTIVES This study was aimed to investigate potential benefits of thoracoscopic surgery for intralobar pulmonary sequestration in adult patients in terms of short-term surgical outcomes when compared with open surgery. METHODS Data of 110 consecutive adult patients undergoing thoracoscopic surgery or open surgery for intralobar sequestration from January 2000 to December 2015 at our institution were reviewed. A total of 42 video-assisted thoracic surgery cases and 68 open surgery cases were identified. Perioperative outcomes were compared between video-assisted thoracic surgery and open surgery to evaluate efficacy. RESULTS Neither group had surgical mortality. Although the overall morbidity was without statistical significance (P = 0.13), pleural effusion that required repeated thoracentesis was less frequent in thoracoscopic surgery (n = 1, 2.4% vs n = 11, 16.2%, P = 0.028). Thoracoscopic surgery was associated with less intraoperative bleeding [193 (standard deviation, SD 238) ml vs 241 (SD 221) ml, P = 0.013] and shorter postoperative stay [5.0 (SD 2.4) days vs 9.5 (SD 3.7) days, P < 0.001] compared with open thoracotomy. No significant difference was found for operation duration (P = 0.51) or chest drainage days (P = 0.11). CONCLUSIONS Video-assisted thoracic surgery is associated with less intraoperative bleeding and shorter postoperative hospital stay than is open thoracotomy in surgical resection of intralobar pulmonary sequestration in adult patients.