Primary spontaneous pneumothorax (PSP): the role of VATS and a new paradigm

The therapeutic management of primary spontaneous pneumothorax (PSP) will include many variables, which alone anticipates difficulties of consensus and challenge to paradigms. Even the recent technological advances and the growing number of publications indicating the need for review the definitive surgical approach to PSP were not able to change the classic guideline. However, they have undoubtedly brought into question the need to add new items to the list. The increase availability of minimally invasive surgery to all surgeons is established as a method of choice in surgical treatment of these patients. The reduction in hospitalization time, impact on care costs, less postoperative pain, high therapeutic resolution by the extinction of the cause and prevention of relapse, reduction of the emotional impact considering the chances of recurrence around 30%, after the first episode and the possibility of early return to the usual activities mainly to young population. These variables support the reflection on method indication at the first episode of PSP. Why not?