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In this study we compared the results of wedge resection and partial pleurectomy in primary spontaneous pneumothorax (PSP) patients treated using video-assisted thoracoscopic surgery (VATS) and axillary thoracotomy approaches. F our-hundred a nd s eventy-eight p atients w ere treated in our clinic for PSP between January 2007 and December 2008. We performed 110 apical wedge resections with a stapler and a partial pleurectomy in 101 patients. Fortyfive of the procedures were performed with VATS (group V) and 65 with axillary thoracotomy (group T) approaches. The two groups were compared with respect to the duration of the procedure, number of stapler reload units used, duration of chest tube, requirement for postoperative narcotic analgesics, postoperative complications, need for reoperation, and recurrence rate. Student's t-test, the chi-square test, and Fisher's exact test were used for the statistical analysis. There were no significant differences between groups V and T in terms of age, gender, smoking habits, pneumothorax side, surgical indications, duration of surgery, postoperative duration of chest tube, postoperative complication rate, reoperation rate, or recurrence rate. Narcotic analgesics were needed in five cases in group V and 20 cases in group T (p=0.02). The mean number of stapler reload units used during the operation was 2.7 in group V and 1.43 in group T (p<0.0001). Both methods can be safely used in PSP surgery. Video-assisted thoracoscopic surgery procedures are less painful, but require more stapler reload units than axillary thoracotomy.