Since Hippocrates times, surgical approaches to the pleura has been described in most of the benign and malignant diseases of the pleura. In this article, these techniques have been discussed under the headlines of 1) closed drainage and suction systems, 2) open drainage, 3) thoracoplasty, and 4) video-assited thoracoscopic surgery (VATS). The differences between old and new techinques in the pleural pathologies are defined, and the clues for the most proper approach to the patients are given.