We report the technique of pericardial approach through the thoracosco
pe. This approach has several advantages. Extensive pericardial fenest
ration can be performed as well as pericardoscopy whenever indicated a
nd additional biopsies such as mediastinal or lung parenchyma biopsies
. Among the 12 patients operated on, the procedure was possible in all
but one case. When there is no contraindication to selective tracheal
intubation or lateral positioning, the thoracoscopic approach is the
method of choice. In other cases, the subxiphoid approach remains indi
cated.