Although there has been progress in video-assisted thoracic surgery (VATS), there have been no reports about the skill needed to perform this surgery for patients with stage I lung cancer. We reviewed a randomized series of surgeons in a single institution and attempted to identify the quality of skill needed in this surgery. Cases of surgery on clinical stage I non-small cell lung cancer (NSCLC) involving 103 patients (56 VATS and 47 conventional approach) from January 2000 to April 2006 were assessed for eligibility. We reviewed these patients and placed them in random order into three surgeon groups (groups A, B, and C) that were based on surgeons who had performed 50 lobectomies through thoracotomy. Three patients were converted to a thoracotomy. Of the remaining 53 patients, 17 were in group A, 15 were in group B, and 21 were in group C. There were no significant differences between the three surgeon groups regarding technical factors such as blood loss and operation time. After a short initial learning period, two of the three surgeon groups significantly decreased total blood loss. Morbidity and recurrence did not differ between the groups, and there was no mortality in our sample. The volume of VATS operations performed by individual surgeons who have had good training in open lobectomy may not make for a positive impact on clinical outcomes. The decision for a VATS lobectomy in cases of stage I NSCLC should not be limited only by a surgeon's thoracoscopic experience.