The review of 68 patients, who were diagnosed as spontaneous pneumothorax during the period from Dec, 1991. to Jul, 1992. were performed thoracoscopy of 70 cases under local anesthesia with 1% lidocaine at the department of thoracic & cardiovascular surgery, HanYang University Hospital. Clinical data on distribution of Age & Sex, Location, Frequency of Reccurrence and other aspects of pneumothorax were summerized.37 cases were treated by thoracoscopic management and closed thoracostomy. As thoracoscopic management, Electrocauterization of bullae or blebs[37 cases], Endo-clip application [2 cases], Removal of foreign body[1 case] were performed. 31 cases were cured by open thoracotomy. The thoracotomy indications under thoracoscopic finding were followed as: 1. Severe pulmonary adhesion and destroyed lung parenchyme 2. multiple bullae or blebs on several areas 3. finding of pulmonary tuberculous caseous lesion 4. persistant air leakage after 7 days from thoracoscopic management Excision, wedge resection of bullae or blebs was performed in most cases [22 cases], 2 cases by median sternotomy and Segmentectomy of 7 cases were carried out depending on the pathologic change of lung.There was no operative mortality and Follow-up for all patients were showed good results.