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Introduction: The objective of this study is to report the impact of computed tomography (CT) screening on the use of Video-Assisted Thoracic Surgery (VATS) in a randomized screening trial., Methods: The Danish Lung Cancer Screening Trial is a randomized clinically controlled trial of 4104 smokers and previous smokers who were randomized to either screening with five annual low-dose CT scans or no screening in Copenhagen from 2004 to 2006. The major end point is the effect of CT screening on lung cancer mortality and treatment options. All diagnostic and treatment interventions in both groups were monitored prospectively until 1 to 3 years after the last screening round., Results: By February 1, 2011 68 cases of lung cancer were detected in the screening group. Furthermore, seven patients with a benign nodule underwent surgical treatment because of suspicion of malignancy (12%). Fifty-one of the 68 lung cancer patients were eligible for surgical treatment. Eight patients had open thoracotomy. Of the operations for lung cancer, 84% were performed by VATS in the CT-screened arm, significantly higher than the control arm (p < 0.05). Thirty-six patients had a VATS lobectomy. One patient had a VATS segmentectomy, and four patients had a VATS wedge resection. The seven benign nodules were all treated with VATS., Conclusions: CT screening seems to facilitate the use of VATS in the treatment of lung cancer with an 84% rate in our data. Furthermore, all benign nodules could be removed by VATS. In our view, a basic requirement for a surgical institution to be involved in lung cancer CT screening is a dedicated VATS program.