Spontaneous pneumothorax is a pathophysiological condition caused by gas entering the pleural cavity without trauma or human factors, resulting in pneumothorax. It can be divided into primary and secondary. Primary spontaneous pneumothorax refers to the occurrence of pneumothorax in healthy individuals without underlying lung disease, mostly in lean and tall male young adults, and is associated with the rupture of pulmonary blisters, but the cause of the formation of pulmonary blisters is unknown and may be related to smoking, height, body size, small airway inflammation and non-specific inflammatory scarring or congenital dysplasia of lung tissue. Secondary spontaneous pneumothorax occurs in patients with underlying lung diseases, such as chronic obstructive pulmonary disease (COPD), tuberculosis, lung cancer, lung abscess, pneumoconiosis, etc., and is mostly seen in middle-aged and elderly people. Clinical manifestations The severity of pneumothorax symptoms is related to the presence or absence of underlying lung disease and lung function, and the amount of air accumulation in the pleural cavity. If there is already severe pulmonary hypoplasia, even if the amount of air accumulation is small, there is obvious dyspnea; while some young people may have very mild symptoms even if the lung compression is more than 80%. Some patients may have triggers such as lifting heavy objects too hard, coughing violently, holding their breath, or even laughing before the onset of the disease, or it may occur during normal activities or at rest. Most patients have sudden onset of the disease and feel sudden chest pain, chest tightness and dyspnea on one side, which may be accompanied by irritating cough. In a few patients, bilateral pneumothorax occurs, with dyspnea as the main manifestation. Imaging examination X-ray chest film is an important method to diagnose pneumothorax, which typically shows a thin line shaped shadow with convex arc, increased translucency outside the line, no lung texture, and compressed lung tissue inside the line. Treatment methods 1.Conservative treatment There are methods such as strict bed rest, puncture and suction, closed chest drainage, etc., but the recurrence rate is high and easy to recur. 2.Surgical treatment Conventional open-chest surgery, because of the trauma, postoperative pain lasting a long time, long recovery time, and large surgical scars, affecting the beauty. With the continuous development of minimally invasive surgery, lumpectomy technology has been continuously advanced. Television thoracoscopic surgery has been widely used in the treatment of various diseases of the chest, including: hand sweating, spontaneous pneumothorax, biopsy of chest lesions, lung diseases, esophageal cancer, and even cardiac surgery. Compared with conventional open surgery, thoracoscopic surgery is less invasive, has faster recovery, and has satisfactory outcomes. All most experts believe that spontaneous pneumothorax is one of the best indications for thoracoscopic surgical treatment. However, due to the influence of traditional thoracoscopic surgery, most doctors in China still use two operating holes in the treatment of spontaneous pneumothorax by thoracoscopic surgery. The difference between traditional two-operator thoracoscopy and single-operator thoracoscopy is the additional main operating hole located in the posterior axillary line. Undeniably, this mode of operation has the following advantages; 1. The operating instruments can be entered through different apertures, avoiding interference between operating instruments and easy exposure. 2, The smoke produced by the electric knife can be discharged smoothly through one of the holes. 3.In case of bleeding, it is more favorable to stop the bleeding with the suction device in cooperation with other instruments. 4. For patients with heavy thoracic adhesions, the approach is safer. However, the posterior axillary line operation hole also has its disadvantages: 1, due to the posterior thoracic wall muscle level, rich blood supply, easy to bleed and longer time to stop bleeding after bleeding. 2. Due to the neuromuscular reason of the posterior thoracic wall, patients often feel obvious pain and have abnormal sensation and mild motor impairment after surgery.