Ten cases of pericardial effusion operated on by VATS are presented. Five patients had unspecified effusion, 3 due to breast cancer and 2 by direct invasion of lung cancer. In this series thre were 4 cases of cardiac tamponade and six presented with severe dyspnea. Pericardial effusion was accompanied by pleural effusion in 7 cases. In 3 of them it was the only expression of the disease. In all cases a large pleuropericardial window was performed, in addition to pleural biopsy and electrocautery pleurodesis. There were neither morbidity nor mortality in this series. We conclude that VATS is an excellent method to resolve pericardial effusions without a previous diagnosis, in which medical treatment failed and results of pericardiocentesis were not long lasting.