OBJECTIVE: To evaluate the value of video-assisted thoracospic surgery (VATS) for the treatment of pediatric empyema thoracis. METHODS: Forty three children with empyema thoracis between January, 1992 and February, 2001, over a period of 9 years, were treated by conventional therapy (thoracentesis, chest tube drainage or thoracotomy debridement; Group A, n=28) and VATS (Group B, n=15). Postoperative parameters of the two groups were reviewed retrospectively. RESULTS: The duration of fever, antibiotical therapy, chest tube drainage and hospitalization in Group B was shorter than those in Group A [( 2.8 d ± 1.7 ) d vs ( 5.7 ± 2.1 ) d, ( 7.6 ± 2.5 ) d vs ( 13.8 ± 4.7 ) d, ( 3.8 ± 1.6 ) d vs ( 5.8 ± 2.4 ) d, ( 10.4 ± 3.0 ) d vs ( 17.8 ± 5.6 ) d, respectively] (P< 0.01 ). There was no difference in the incidence of postoperative complications and in mortality between the two groups. CONCLUSIONS: VATS for empyema thoracis was efficacious and less traumatic, and the duration of treatment was short. However, the treatment should be intervened as early as possible.