Regardless of its origin, the treatment of persisting or recurring spontaneous pneumothorax (SP) is classically surgical. To assess the contribution of thoracoscopy in the management of SP 100 consecutive patients with persistent or recurrent pneumothorax were treated at our unit by endoscopic procedure between 1992 and 1997 to obtain permanent pleurodesis and to treat the lung lesion responsible for the leak. There were 90 men and 10 women ranging in age from 16 to 60 years (mean age 28±12 years). The technique includes electrocoagulation of pleural blebs and thoracoscopic apical pleurectomy. All patients were subjected to physical examination and plain x-ray at 1 and 3 months and 1 year postoperatively. After completion of the procedure, air leaks disappeared in 90 cases, while 5 cases air leak ceased 5 to 7 days postoperatively. The remaining 5 cases were converted to an open procedure. The mean length of follow-up was 3 years. No patient required transfusion and there were no operative deaths. No recurrence of pneumothorax occurred and no major complications encountered. Video-assisted thoracoscopic pleurectomy for the treatment of pneumothorax is concluded to be that safe and efficacious. It shortens the hospital stay, requires less amount of postoperative narcotic analgesia.