Objective To compare the short-term outcomes of single-port video-assisted thoracoscopic （VATS） pulmonary surgery using a chest-wall-muscle-sparing incision versus a standard incision. Methods A total of 215 patients undergoing single-port video-assisted thoracoscopic lung surgery in the Department of Cardiothoracic Surgery， The First Hospital of Anhui University of Science & Technology from February 2024 to May 2025 were recruited in this clinical observation. Clinical data were retrospectively analyzed. The patients were divided into a chest wall muscle sparing incision group and a chest wall standard incision group. Short-term prognoses of the two groups were compared. Results A total of 180 patients was included： 80 in the chest wall muscle sparing incision group and 100 in the chest wall standard incision group. The two groups had similar baseline characteristics， including body-mass index （23.86 ± 3.70 vs. 23.45 ± 3.20 kg/m2； P > 0.05）. All procedures were completed successfully without perioperative mortality， conversion to thoracotomy， or extension of the incision. The standard incision group had 4 latissimus dorsi injuries and 5 patients with shoulder joint dysfunction on the 30th day after discharge， characterized by chest wall muscle tightness accompanied by chest pain and limited upper limb mobility （P < 0.05）. Although skin-to-skin incision time was slightly longer in the muscle-sparing group （P = 0.06）， pain scores at every assessed time point were significantly lower （P < 0.05）， and no patient developed shoulder dysfunction. No significant differences were observed in incisional fat-liquefaction rate， incision length， operative time， blood loss， or chest-tube duration （P > 0.05）. Conclusion The chest wall muscle sparing incision in single-port video-assisted thoracoscopic lung surgery not only preserves the latissimus dorsi and serratus anterior muscles， significantly reduces postoperative incision pain， and minimizes chest wall muscles and shoulder dysfunction， exhibiting clear minimally invasive advantages in single-port VATS lung surgery.