Objective To investigate the clinical significance and effectiveness of thoracic endoscopic surgery for patients with severe thoracic trauma. Methods 68 cases of severe thoracic trauma with thoracoscopic operation, of which 36 cases underwent internal fixation of rib fracture and 32 cases were performed by thoracoscope. The VAS score, analgesic dosage, bed time and hospitalization days were compared between the two groups. Results There were significant differences in VAS score, analgesic dosage, bed time and hospitalization days after operation in the two groups. Conclusion The treatment of severe thoracic trauma by thoracoscopic surgery and internal fixation of rib fracture may reduce postoperative complications and accelerate the recovery of patients, which is worth popularizing.