Objective?To compare the efficacy of uniportal VATS and single utility port VATS in treatment of spontaneous pneumothorax.?Method?From January 2013 to December 2015, we retrospectively collected clinical data of 53 patients with spontaneous pneumothorax who were treated with uniportal VATS, as study group; compared with control group: 53 patients received single utility port VATS in the same period. The clinical data was compared between the two groups, including the operation time, intraoperative blood loss, drainage time, postoperative extubation time, postoperative pain score, postoperative hospitalization and recurrence.?Results?All patients were successfully completed the operation, no death and serious complications occurred. There were no significant differences in intraoperative blood lose, duration of chest drainage, duration of hospital stay and incidence of serious postoperative complications between two groups (P > 0.05). Mean Visual Analogic Scale (VAS) score for 24 h post-operative pain was: (2.60 ± 0.71) for uniportal VATS and (3.38 ± 0.84) for single utility port VATS (P > 0.05), 72 h post-operative pain was: (1.30 ± 0.51) for uniportal VATS and (1.58 ± 0.62) for single utility port VATS (P > 0.05). Follow up 5 ~ 36 months, median follow up was 19 months. No recurrence occurred during follow up.?Conclusions?The study suggested that both surgical approaches to spontaneous pneumothorax are safe and effective. Significant differences were found for early post-operative pain between the two approaches, the uniportal way is better. It is worthy of clinical promoting.