**Figure 3.**

*Bubbling test after stapling an apical bulla. More stapling was needed until the lung was watertight.*

**Figure 4.** *Multiple apical bullae hiding within an azygos lobe.*

From the above discussion, it is unreasonable to assign increased recurrence rates to the way we access the chest cavity. Access should never matter. Minimal access surgery has leapt to the forefront of access choices preferred by patients. It has proven to result in less postoperative pain, less usage of analgesics and antiemetics, early recovery, less stay in hospital and early return to work. Therefore, it is very unlikely to advocate open thoracotomy as a first-choice procedure on the basis of the previously mentioned systematic reviews alone.
