We treated 40 consecutive cases of spontaneous pneumothorax (SP) with video-assisted thoracic surgery (VATS) in 2004. To develop and introduce a clinical pathway (CP) of VATS for patients with SP, we reviewed the 40 cases in this study. All patients were managed before and after surgery according to the newly established program through manuals and an ordering system (including intravenous infusion, radiography, laboratory tests, and prescriptions). The 40 patients were 35 men (87.5%) and 5 women, with an average age of 30.5 years. In addition, 27 patients (67.5%) were younger than 30 years. The operation sites were right, 18 cases; left, 20 cases; and bilateral, 2 cases. The average surgical duration was 65.6 minutes (excluding 2 bilateral cases). The postoperative duration of thoracic drainage was 1.7 days, and the drain was removed the day after surgery in 35 of 38 patients (excluding the bilateral cases). Only 2 patients (5%) required drainage for more than 1 week. The postoperative stay was 3.2 days; 21 patients (52.5%) were discharged on the second day after surgery, and 8 patients (20%) were discharged on the third day. In addition, 2 patients required hospitalization for more than 1 week. These results show that our programmed management system using VATS for patients with SP is effective and appropriate as a clinical pathway.