Further improvements in the thoracoscopic treatment of spontaneous pneumothorax may reduce the already low invasiveness of the procedure. We have recently experimented with a new device for the coagulation of blebs as an alternative to endostapler resection. Patients with recurrent or persistent spontaneous pneumothorax underwent thoracoscopic treatment. Those with blebs or small bullae were treated with a new device, based on coupling saline solution perfusion with radiofrequency energy. Most operations were performed making only two incisions, in some cases under awake epidural anaesthesia. Results are comparable to those of a series of standard thoracoscopic treatments already reported in the literature.