Setting: University referral center. Patients: Six consecutive patients with a pneumothorax who underwent video-assisted thoracic surgery through a single skin incision. Interventions: A flexible digital bronchoscope was placed in a scope guide. A single 2.0-cm skin incision was made in the midaxillary line. The entire lung was carefully explored. An endoscopic stapling device was then inserted, and the lung resection was performed through a single skin incision. Primary Outcome Measures: Operative time, estimated amount of blood loss, operative complications, and postoperative air leakage were recorded. Results: The video-assisted thoracic surgery procedure throughasingleincisionwassuccessfulinall6patients.There were no associated complications at 1-year follow-up. Conclusions: We were able to perform the videoassisted thoracic surgery procedure through a single skin incision using a scope guide and a flexible scope that enables visualization of the entire pleural cavity, providing even laser ablation. This new technique can be used to treat patients with pneumothoraces without the need for additional skin incisions.