Background <p>A standard treatment for pneumothorax due to bleb rupture is thoracoscopic blebectomy, often combined with pleurodesis to reduce recurrence risk. However, pleurodesis can cause significant postoperative pain. This study evaluates the efficacy of the no-knife endoscopic stapler blebotomy without pleurodesis using video-assisted thoracoscopic surgery (VATS) for spontaneous pneumothorax.</p> Methods <p>We conducted a retrospective chart review of patients treated with no-knife endoscopic stapler blebotomy for spontaneous pneumothorax at UCSF Benioff Children’s Hospital Oakland from 2020 to 2024. The procedure involved using the no-knife endoscopic stapler for blebotomy without performing pleurodesis. Post-procedure air leaks were monitored with a chest tube. We analyzed postoperative chest tube duration, pain levels, and recurrence rates.</p> Results <p>The study included eight male patients with a median age of 17 (range 15-19). Apical blebs were identified thoracoscopically in all patients and stapled off using the no-knife stapler. No intraoperative or postoperative complications occurred. The median postoperative chest tube duration was 2 days (range 1-3). The mean pain score on postoperative day 1 was 1.3 (range 0-10). Over a median follow-up of 24 months (range 6-36), no pneumothorax recurrence was observed.</p> Conclusion <p>No-knife endoscopic stapler thoracoscopic blebotomy is a safe and effective procedure. Avoiding pleurodesis reduces postoperative pain and morbidity.</p> Level of evidence <p>Level 4, Observational study.</p>