Brittle asthmatic with recurrent pneumothorax - been told i will need surgery, who gets to choose between vats/open thoracotomy, me or the surgeon?

Surgeon: If you have recurrent pneumothorax then you may have pulmonary blebs which will need surgery to treat. This is usually treated with VATS surgery but it is up to your surgeon. VATS is less painful and quicker recovery time. If you would prefer a VATS, find a thoracic surgeon who specializes in minimally invasive surgery.

You have to choose: both procedures are equally effective but the open procedure is more invasive

Joint decision: There are benefits and some small risks of each procedure, so each should be discussed together with your surgeon. I would suggest a screening test for CF and also for alpha 1 antitrypsin deficiency if there are findings consistent with the disease. I hope things proceed well.