Primary spontaneous pneumothorax is a type of pneumothorax occur in a patient who has no underlying pulmonary disease. The purpose of this study was to conduct a systematic evaluation of research on the efficacy of tube thoracostomy vs manual aspiration in treating spontaneous pneumothorax. The 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement used as the guide for this investigation. From 2012 to 2024, we searched the Cochrane Library, PubMed, and EMBASE. Only full-text publications published in English were included in the search. We also searched review references and included the relevant publications we found to ensure that all relevant literature was reviewed for our analysis. A total of 342 patients from 5 randomized controlled trials were included in this investigation. A shorter hospital stay and fewer adverse events are the outcomes of beginning treatments with manual aspiration as opposed to tube thoracostomy. Manual aspiration is an effective first treatment for patients experiencing their first episode of primary spontaneous pneumothorax. The manual aspiration technique is similar to tube thoracostomy in terms of quick lung re-expansion in spontaneous pneumothorax patients.