Awake thoracoscopic pericardial window is safe and feasible.

Background: Pericardial window is the definitive treatment for pericardial effusions. Minimally invasive approach has certain advantages that favor its utilization but requires general anesthesia. These include potential patient advantages such as less pain, less morbidity, and shorter length of stay and surgical advantages such as better visualization of the pericardium. However, general anesthesia may pose increased risk for certain patients which may prohibit traditional minimally invasive approaches. Case Description: We present a four-case series of awake thoracoscopic pericardial window procedures performed in a tertiary care hospital from 2013 to 2021. Thoracic surgery consultation was requested on these patients with pericardial effusions. Patient's age ranged from 31 to 80 years with equal sex distribution and a variety of medical co-morbidities. The majority of the patients had undergone pericardiocentesis but recurred. Due to concerns regarding the patients' ability to tolerate general anesthesia, awake surgery was offered to these patients. Awake thoracoscopic pericardial window was performed with concomitant pleural and/or mediastinal procedures with operative times ranging from 52 to 95 minutes. The majority of patients had non-malignant etiologies. All patients did well peri-operatively without any complications. The chest tubes were removed in 2-7 days and the patients were discharged from the hospital in 2-10 days. Conclusions: Awake thoracoscopic pericardial window can be safely performed for patients and offers both diagnostic and therapeutic benefits to even those who are not candidates for general anesthesia.