The best preventive procedure is video-assisted thoracic surgery (VATS) in which blebs are stapled and pleurodesis is done with pleural abrasion, parietal pleurectomy, or talc insufflation; in some medical centers, thoracotomy is still used. These procedures are recommended when catheter aspiration fails to resolve spontaneous pneumothorax, when pneumothorax recurs, or when patients have secondary spontaneous pneumothorax.