This study aimed to compare the feasibility, efficacy and safety among uniport video assisted thoracoscopic surgery (U-VATS), multiport VATS (M-TATS), and open thoracotomy in elderly non-small cell lung cancer (NSCLC) patients at early stage. One hundred ninety-one elderly NSCLC patients at early stage underwent U-VATS (N=73), M-VATS (N=56) or open thoracotomy (N=62) were included. Perioperative parameters, short-term outcomes, postoperative complications, and overall survival (OS) were assessed. Three-group analysis disclosed that operational duration, blood loss, drainage duration, hospital stay, pain score on the first day (D1) and D3, patients' global assessment (PGA), lasing air leak, infection, arrhythmia, and cardio-cerebrovascular events incidences were different among U-VATS, M-VATS, and open thoracotomy groups. Subsequently, 2-group analysis revealed that: 1. Pain score on D1 and D3 and PGA score were decreased in U-VATS group compared with M-VATS group; 2. The operational duration was longer, blood loss, drainage duration, hospital stay, pain score on D1 and D3, PGA score, lasing air leak, infection, arrhythmia, and cardio-cerebrovascular events were decreased in U-VATS group than open thoracotomy group; 3. The operational duration was longer, blood loss, drainage duration, hospital stay, pain score on D1 and D3, lasing air leak, infection, and arrhythmia were reduced in M-VATS group than open thoracotomy group. In addition, there was no difference of OS among 3 groups, nor between any of the 2 groups. U-VATS presents with elevated feasibility, non-inferior tolerance, and similar efficacy compared with M-VATS and open thoracotomy in the elderly NSCLC patients at early stage.