We employed an ultrasonic scalpel, the Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH), for thoracoscopic limited pericardial resection in consecutive 10 patients with massive pericardial effusion or pericarditis. The mean operative time was 27 minutes for pericardial effusion. No dangerous arrhythmias were induced even in the patient with dense pericardial adhesions. There were no operation-related complications or deaths. The thoracoscopic ultrasonic scalpel technique can be an efficacious minimally invasive alternative for pericardial window.