Since May 1990 we have treated 35 patients with spontaneous pneumothorax and without underlying lung disease by thoracoscopic operation. All patients entered a prospective trial. There have been four recurrences during a minimum follow-up of 7 months (median 19 months). Two complete collapses had had only fibrin glue sealant without any resection of bullae. The others were partial relapses not requiring any treatment. There was a striking high incidence of pain complaints and sensory disturbances (13 out of 29) even months after pleurodesis by coagulation or pleurectomy. Reduced trauma and less postoperative restriction of pulmonary function together with low recurrence rates suggest a more liberal indication in patients with their first manifestation of the disease. Nevertheless indication and choice of pleurodesis should be restrictive and be studied further for its specific complications.