The length of incision for the thoracotomy has been shorten relatively to the past. Para-scapular bow incision was over 30 cm in length but the axillary incision is a half of it. Now we have the minithoracotomy in 3 cm and the thoracoscopic treatment in 1 cm. Spontaneous pneumothorax is the best indication of thoracoscopic treatment because of the followings: 1. Pneumothorax is a benign disease. 2. Cause of air leak is rupture of the bulla which is located on visceral pleura. 3. Thoracic cavity is already opened in patients with pneumothorax. In our Center we have over 2,800 cases of spontaneous pneumothorax and we have treated thoracoscopically over 2,000. Electro-coagulation and/or YAG-LASER were used to destroy bullae within 1 cm in diameter. Looping and/or ENDO-AUTO-SUTURE devices has been used for bullae over 1 cm in diameter. Today recurrence rate is under a few% and no complications. Thoracoscopic treatment is the best way to cure the spontaneous pneumothorax and now it is the finest choice to manage of it.