This video demonstrates the technique of thoracoscopic pericardiectomy in two clinical situations. The first case is that of a benign recurrent idiopathic pericardial effusion. Pericardiocentesis had been performed on three prior occasions with recurrence of the effusion. The second case is a dialysis dependent patient with a recurrent pericardial effusion who was symptomatic and demonstrates the pericardial adhesions that are sometimes encountered in uremic patients.