This retrospective study aimed to evaluate the safety and efficacy of thulium laser pulmonary wedge resection under thoracoscopy.Sixty cases of thoracoscopic pulmonary wedge resection by thulium laser and sixty cases with mechanical stapler from February 2015 to September 2018 were selected. The operation time, intraoperative hemorrhage, postoperative hospital stay, severe air leaks, drainage time, and complications (including postoperative hemorrhage, hemoptysis, atelectasis, and pulmonary infection) were compared between groups.The thulium laser group showed a lower incidence of intraoperative hemorrhage (10.0 [5.0-20.0] ml vs. 15.0 [10.0-50.0] ml, P = 0.010) and a shorter postoperative hospital stay (3.9 ± 2.5 days vs. 4.9 ± 2.0 days, P = 0.031).There was no significant difference between groups in the operation time, postoperative drainage time, the occurrence of severe air leaks, or complication rate (P > 0.05). No patients were lost during follow?up (median follow?up time: 28.4 months, range: 18.0-36.0 months). No statistically significant difference in overall survival was found (P = 0.547).pulmonary wedge resection with thulium laser under thoracoscopy had better safety, less damage, and higher accuracy compared with the control group.