E.I. Sigal, R.G. Khamidullin. Spontaneous pneumothorax is one of the most common indications for video-assisted thoracoscopy. The most common causes of pneumothorax include bullous lung disease, emphysema, congenital polycystic lung disease, and lung tissue damage due to rib fractures. The goal of the surgery is to eliminate the pneumothorax and, in spontaneous pneumothorax, obliterate the pleural cavity. Surgical technique. A trocar is inserted into the pleural cavity through the 5th or 6th intercostal space along the midaxillary line. The pleural cavity is inspected for adhesions. Under visual control, the working trocars are inserted into the pleural cavity: into the 3rd intercostal space along the anterior axillary line and into the 5th intercostal space along the midclavicular line. This placement of the thoracoports is convenient for manipulations in the upper lobe, where bullae are most commonly localized. During pleural cavity inspection, particular attention should be paid to the presence and size of bullae, particularly identifying disruptions to the integrity of the lung parenchyma and visceral pleura due to rupture of thin-walled bullae. To detect hidden damage to the lung parenchyma, fluid (usually isotonic sodium chloride solution) is introduced into the pleural cavity and the lung is inflated; the appearance of air bubbles allows one to determine the location of the defect. Large bullae (more than 2 cm in diameter) and lung injuries require the application of an endoloop, manual or machine suture. Gradual inflation of the lung confirms the reliability of pneumostasis (Fig. 1). Bullae less than 2 cm in diameter are electrocoagulated. Pleurodesis or pleurectomy is performed to obliterate the pleural cavity. - is performed from the second to the seventh intercostal space. The pleura is incised along the rib with an electrocoagulation hook or scissors, separated from the underlying tissue, and removed. Hemostasis is ensured by electrocoagulation of bleeding vessels with a spherical electrode (Fig. 2). - Mechanical pleurodesis. The parietal pleura in the upper lobe of the lung is rubbed with a gauze swab until capillary bleeding occurs. - Chemical pleurodesis with talc. 3-6 g of talc powder is insufflated into the pleural cavity. - Obliteration of the pleural cavity can be achieved by electroscarification of the parietal pleura. For this, the parietal pleura is electrocoagulated along the ribs with an electrocoagulation hook or spherical electrode. The operation is completed by draining the pleural cavity with one or two drainage tubes and inflating the lung under visual control. The drainage tubes are connected to a vacuum aspirator with a constant negative pressure of approximately 20 mm H2O. Postoperative period. Chest X-rays are performed daily to monitor the condition of the lungs and pleural cavities. The drainage tubes are removed after pneumostasis is established (usually on the 2nd or 3rd day). Complications and prevention. To prevent recurrent pneumothorax in the postoperative period, careful care of the drainage tubes and maintenance of a constant negative pressure in the pleural cavity are necessary. This is a highly effective procedure.