Vertical axillary muscle sparing thoracotomy is newly appeared and excellent alternative method of standard posterolateral thoracotomy.It has many advantages compared to standard posterolateral thoracotomy , less postoperative pain, well preserved thoracic muscle strength, full range of motion of the shoulder girdle and attractive cosmetic results. We performed vertical axillary muscle sparing thoracotomy in 36 patients from November 1993 to July 1994. The ages of the patients ranged from 6 months to 71 years[mean 45.1 years , and the patients consisted of 20 males and 16 females.The preoperative diagnosis were as follows : lung cancer in 17 patients, tbc destroyed lung in 7, bronchiectasis in 3, bullous emphysema in 3 and the others are mediastinal tumor, bronchogenic cyst, lung abscess, empyema, esophageal diverticulum, and CCAM [congenital cystic adenomatoid malformation . The operative procedures were as follows : lobectomy and bilobectomy in 16 patients, segmentectomy in 4, wedge resection in 3, penumonectomy in 7, and the others were open biopsy, lobectomy with diaphragm excision, sleeve right upper lobectomy, decortication, mediastinal mass excision, and esophageal diverticulectomy. We had 6 complications : postoperative bleeding in 2 cases, operative wound infection, arrrhythmia[atrial fibrillation , Horner`s syndrome, hoarseness. The subcutaneous seroma occurred in 4 cases but did not require drainage and relieved within 4 weeks spontaneously. We concluded that vertical axillary muscle sparing thoracotomy could be done in most of all thoracic surgery with safety. Comparing to standard posterolateral thoracotomy vertical axillary muscle sparing thoracotomy has many advantages such as less postoperative pain, well preserved muscle strengths and good cosmetic results.