Background: primary spontaneous pneumothorax remain a significant problem occurring in healthy subject. The risk of recurrence is 54% within the first 4 years. Bullectomy combined with pleurectomy using VATS technique is safe and effective and requires only a short hospital stay. The aim of the study is to evaluate the safety and efficacy of VATS in management of primary spontaneous pneumothorax compared to open thoracotomy. Methods: from jan.2006 to June 2008, all patients required bullectomy and pleurectomy by thoracotomy (limited posterolateral or transaxillary) or VATS due to recurrent primary spontaneous pneumothorax or first attack of primary spontaneous pneumothorax with failure of lung expansion by thoracostomy tube and massive air leak were included in this study. Results: there were 37 patients, 23 male and 14 female with a mean age 27.9+18.3 years. The right lung was affected in 21 patients and 16 were in the left lung. 15 patients (40.5% ) underwent trans-axillary thoracotomy, nine patients (24.3%) with limited posterolateral thoracotomy, while VATS was carried out on 13 patients (35.2%). The median operating time was significantly longer in open group than VATS group (75.34+ 22.1 vs. 54.9+ 16.2 min.). The amount of analgesia required(morphine consumption) in the first 5 days was significantly more in thoracotomy group (150.5+52mg. vs. 55+22mg.). Chest drainage was significantly more in open group (1027.4 + 230 ml. vs. 643.8+ 120 ml. ).However, chest drain duration and hospital stay had no significant difference. Conclusion: VATS is safe and effective technique for bullectomy and pleurectomy and we can consider that VATS is the technique of choice for surgical treatment of primary spontaneous pneumothorax.