Background: Nowadays, video-assisted thoracoscopic surgery (VATS) is the management of choice for primary spontaneous pneumothorax (PSP). This prospective study was designed to address the efficacy and the possible advantages of using uniportal VATS when compared with triportal VATS in management of PSP. Method: A total of 80 VATS procedures were randomly done for PSP. 40 procedures were performed with uniportal VATS compared to 40 procedures performed with triportal VATS in the management of PSP. Patients were followed-up for 12 months postoperatively. Results: Both uniportal and triportal VATS have the same efficacy in managing PSP. There is no difference between both techniques regarding postoperative bleeding and air-leak (p=1.0). Uniportal VATS has a shorter operative time (66.32±3.46 vs 72.95±6.08 minutes, p<0.001). Adding another port wasn’t needed in uniportal VATS, while it was needed in 6 (15%) patients in triportal VATS group (p=0.026). Uniportal VATS has a statistically significant difference regarding postoperative pain duration (3.80±1.04 vs 4.32±0.47 days, p=0.005), early postoperative pain scale by visual analogue pain scale (1.77±1.02 vs 2.37±1.25, p=0.022), chest tube duration (4.85±0.57 vs 5.07±0.26 days, p=0.029), postoperative paresthesia (0.05±0.22 vs 0.90±0.74, p<0.001), postoperative hospital stay (5.45±0.50 vs 5.87±0.75 days, p=0.004), and better cosmesis (2.35±0.62 vs 1.92±0.65 on scale 1-3, p=0.004). Conclusions: Uniportal VATS is a safe and a feasible approach in management of PSP. Uniportal VATS is a good alternative to triportal VATS due to its efficacy in decreasing postoperative pain, paresthesia, total duration of hospital stay and in providing better cosmesis.