Minimally invasive surgical approaches for pneumothorax: evolution and current perspectives.

Introduction: PubMed was used for a literature search (1990-2025) on the minimally invasive surgical approaches for pneumothorax, which have evolved markedly, with video-assisted thoracic surgery (VATS) emerging as a preferred procedure. Systematic reviews of randomized control trials indicate that VATS is less invasive than traditional thoracotomy. Furthermore, uniportal VATS provides less postoperative pain and better cosmetic outcomes than thoracotomy. Currently, uniportal VATS seems preferred as the minimally invasive surgical approach for pneumothorax. New devices such as small-diameter thoracoscopes and forceps, which are used in uniportal subxiphoid VATS and uniportal subcostal robot-assisted thoracic surgery, may contribute to reducing the postoperative incidence of intercostal neuralgia and enhancing satisfaction with the cosmetic results.

Areas covered: The ideal surgical approaches for pneumothorax, referencing guidelines, and studies from various countries.

Expert opinion: This review explores various aspects of minimally invasive surgical approaches for pneumothorax. Uniportal VATS for pneumothorax via the intercostal approach is commonly performed worldwide and ensures high surgical quality. This review discusses what should be performed within the thoracic cavity to reduce the postoperative recurrence rate of pneumothorax, problems associated with thoracic adhesions that may be disadvantageous for pneumothorax patients in the future, and the latest surgical approaches that may become mainstream.