The purpose of this study was to compare thoracoscopic treatment for spontaneous pneumothorax in patients over 50 years old (OG) and younger patients (YG). Thoracoscopic treatment was performed in both groups using the same patient selection criteria: persistence of an air leak after tube thoracostomy drainage, ipsilateral recurrence, and bilateral pneumothoraces. Thoracoscopic treatment was performed in nine older patients (OG) over a two-year period. Their ages ranged from 50 to 81 years (average: 66 years). The mean operative time, postoperative drainage period, and hospital stay after surgery were 120 min, 6.3 days, and 10.7 days, respectively. In the YG, these indices were 71 min, 1.5 days, and 5.3 days, respectively. Each factor was significantly prolonged in the OG (p < 0.05). However, there were no major perioperative complications or recurrences 3-24 months after surgery in either group. Thus, thoracoscopic surgery is also effective in the treatment of spontaneous pneumothorax in patients over 50 years old.