Objective:To evaluate the Video Assisted Thoracoscopic surgery (VATS) in the treatment of older patients with spontaneous pneumothorax.Methods:VATS was performed in 21 patients with the age over 60 and just treated by thoracic tube drainage in 58 patients as control. Results: All 21 cases of older patients with VATS treatment of spontaneous pneumothorax are successful without any mortailty.Postoperative drainage period

and hospital stay after surgery of the VATS group were 7.3 days and 14.6 days

which were significantly shorter

and the rate of replace and mortality are significantly lower than the control group. 8 old patients with respiratory failure had recovered gradually after VATS operation. Conclusion:VATS is a safe and effective treatment for old patients with spontaneous pneumothorax. The old patients with spontaneous pneumothorax should be treated earlier in order to reduce the mortality and recurrent rate.