Medical thoracoscopy is an efficient technique to evaluate the gravity of a spontaneous pneumothorax in order to choose the most appropriate treatment. Classification of lesions into four types (from endoscopically normal lungs to large bullae) guides the choice from local talc pleurodesis to surgical bullectomy and pleurectomy. Most patients with the first three types can be treated with talc pleurodesis, with a good success rate (93%) and no functional sequelae (lung volumes within the normal range in primary pneumothorax and similar to previous values in secondary pneumothorax). Neuroleptanalgesia in association with patient-controlled analgesia appears to be superior to local anaesthesia in the prevention of immediate pain induced by talc poudrage. Talc pleurodesis is the treatment of choice for recurring spontaneous pneumothorax because of its high success rate and absence of complications.