Introduction/Objective. Besides sternotomy, video-assisted thoracoscopic surgery (VATS) is used for thymus tumors treatment. The objective of our study was to compare oncological and perioperative outcomes in patients with I?II stage of thymic tumors treated with VATS or standard sternotomy procedures. Method. The study included only primary I?II thymoma according to the Masaoka classification, treated between May 2006 and February 2018. Out of 116 treated patients that had pathohistologically verified stage, 100 (86.2%) were matched by propensity score for sex, age, body mass index, myasthenia, tumor size, Masaoka classification stage. Oncological (direct post-operative survival, recurrence) and perioperative outcomes (intraoperative and postoperative complications, length of hospitalization) that affect the efficacy and safety of surgical techniques have been analyzed and compared between the two groups. Results. Among 50 patients operated by VATS, 34 patients (68%) were treated by uniportal approach, 13 (26%) by biportal and three (6%) by threeportal approach. The VATS intervention had shorter intervention time (p < 0.001), duration of hospitalization (p < 0.001), and usage of thoracic drainage (p < 0.001). There was a significant difference in terms of late control (p < 0.001). There was no significant difference between the groups regarding visual analogue scale score, as well as in terms of the time of recurrence (p = 0.305, p = 0.268). Conclusion. Compared to standard sternotomy, VATS thymectomy is an equally effective and significantly safer method with a minimum rate of intra and postoperative complications.