Parietal pleurectomy is the most effective method of preventing a recurrence of spontaneous pneumothorax. Until recently, however, it has required thoracotomy which is associated with significant morbidity. The advent of video-assisted thoracoscopic surgery (VATS) has offered a less traumatizing method of performing parietal pleurectomy, but experience in this operation is limited. In this study we compared the operative results of our first twelve patients treated using VATS (VATS-group) with twelve consecutive patients operated on via thoracotomy (T-group) before we started using VATS. The groups were comparable in terms of age, sex ratio and the length of preoperative pleural drainage. In the VATS-group peroperative blood loss was markedly less, but the mean operative time was 16 min longer than in the T-group. There was practically no difference in the number of opioid dosages given postoperatively between the groups, but the hospital stay was approximately three days shorter in the VATS-group than in the T-group. Inability to work lasted two weeks longer in the T-group than in the VATS-group. In the T-group there were no recurrences of pneumothorax, but in the VATS-group pneumothorax recurred in two patients. They were both treated using a Roeder loop to excise bullae. One patient was reoperated via thoracotomy and another was treated by pleural suction. The initial Finnish experience of VATS-pleurectomy shows that parietal pleurectomy can be performed safely with less morbidity in the treatment of recurrent spontaneous pneumothorax. However, recurrences in the VATS-group underlines the proper selection of technical methods when using this method of treatment.