Elderly patients with recurrent pneumothorax are mostly secondary to primary lung disease, commonly due to COPD combined with rupture of large alveoli. Due to their age, poor lung function, and the combination of many other primary diseases, they cannot be treated surgically and are mostly treated by closed pleural drainage, which leads to long treatment time, many complications, and recurrent attacks. The clinical application of minimally invasive thoracoscopic techniques and the development of other clinical examination and treatment techniques have brought hope for the treatment of recurrent pneumothorax in the elderly. High-resolution CT examination of the chest can clarify the subtle lung lesions and the extent of emphysema, creating conditions for surgical treatment. Thoracoscopic excision of pulmonary alveoli and emphysematous lung tissue with pleural friction or talc spray, thoracoscopic talc spray for pleural cavity atresia, thoracoscopically guided closed drainage of pleural cavity and pleural cavity atresia can be applied to elderly patients with different conditions, bringing new treatment means for the treatment of elderly recurrent pneumothorax.