To assess the contribution of thoracoscopy in the management of spontaneous pneumothorax (SP) 101 consecutive cases treated in our department were reviewed. The patients were divided into two groups: group 1 was treated conservatively; in group 2 thoracoscopy was performed and in case of an idiopathic SP, pleurodesis was carried out with iodinated talcum. Group 1 consisted of 51 patients of whom 28 were considered to have a symptomatic SP (1A) and 23 an idiopathic SP (1B). The recurrence rate was 46 and 26%, respectively. Group 2 consisted of 50 patients of whom 12 had a symptomatic SP (2A) and 38 an idiopathic SP (2B). In group 2A, thoracoscopy provided the indication for primary surgical intervention in 3 patients. Patients in group 2B were treated by chemical pleurodesis with iodinated talcum. In only 1 did a recurrence occur. Complications of thoracoscopy and/or pleurodesis were not observed. We conclude that thoracoscopy enables accurate assessment of the type of pneumothorax, and can play an important role in the management of SP. Chemical pleurodesis causes a significant reduction of the recurrence rate in the treatment of idiopathic SP.