The aim of this case report was to analyse the efficiency of video-assisted thoracic surgery (VATS) in the treatment of spontaneous pneumothorax. Spontaneous pneumothorax occurs subsequently to a disruption of visceral pleura and escape of air into pleural space. A retrospective study was performed in 5 patients from December 2001 until May 2006. Four procedures for recurrent spontaneous pneumothorax and one procedure for primary spontaneous pneumothorax were performed. The main symptoms in our patients included chest pain (100%), shortness of breath (60%) and cough (10%) In all patients we made routine X-rays and CT scans. With CT scans in four patients we detected apical bullae. In one patient we had not appropriate diagnosis and we made VATS as diagnostic and later therapeutic procedure. In all patients bullae were in apical zone and resected with endostapler device. There was no postoperative mortality or any complications after VATS. The median duration of the operation was 75 minutes (65-120 minutes), and postoperative hospital stay was 6 days (range 5 to 8 days). On the basis of our results and results from literature we conclude that VATS allows effective, safe performance of standard surgical procedures, avoiding a formal thoracotomy incision (Ref. 15). Full Text (Free, PDF) www.bmj.sk.