We report our first experience in surgical treatment of recurrent spontaneous pneumothorax using video-assisted thoracic surgery (VATS). From May 1995 to April 1998, 38 cases of recurrent spontaneous pneumothorax were treated using the VATS approach. All patients were previously treated by other methods (conservative, thoracocentesis, chest-tube drainage). We successfully managed VATS procedure in all our patients (wedge resection 28, bullectomy 1, partial pleurectomy 2, pleural abrasions 36). Complications include persistent air leak (4), prolonged bleeding (1) and supraventricular tachycardia (1). The mean duration of chest drainage was 3.9 days (range 3 to 15 days). All patients received antimicrobial chemoprophylaxis with single-dose of 2 g Ceftriaxone intravenously prior to surgery and average postoperative patient-controlled analgesia with 0.15 mg of buprenorphin. Utilisation resource analysis showed great advantage in favour of VATS procedure compared to retrospectively analysed thoracotomied patients. We conclude that VATS is very useful alternative to conventional thoracotomy in managing cases of recurrent spontaneous pneumothorax.