Video-assisted thoracoscopic surgery (VATS) has been suggested as the most appropriate choice for spontaneous pneumothorax. Thirty-two patients (30 males, two females, age range from 16 to 42) with primary spontaneous pneumothorax (PSP) are reported. All had mechanical pleurodesis with Marlex mesh. Blebs or bullae could be identified in 24 patients (75%). All bullae over 2 cm were either excised (11 patients) or ligated (five patients). The median operating time was 45 min. There was minimal postoperative discomfort and the median postoperative hospital stay was 4 days. There was one minor wound infection and one recurrence (mean follow up of 11 months). It is concluded that VATS is a quick, safe and effective approach for the treatment of PSP. Long-term results will better define its true merit in thoracic surgery.