Intrapericardial pneumonectomy is a major thoracic surgical procedure which is employed to resect locally advanced bronchogenic carcinoma. The procedure differs slightly in the left side than in the right side due to the anatomical differences of the two pulmonary hila and adjacent mediastinal structures. The common beginning of the operation is the longitudinal opening of the pericardium behind the phrenic nerve. On the left side, the pulmonary artery is dissected under the aortic arch and the ligamentum arteriosum is divided. Subsequently, the superior and inferior pulmonary veins are dissected and prepared intrapericardially and finally the bronchus is prepared posteriorly to the hilum. On the right side, the pulmonary artery is dissected from the superior vena cava and the procedure follows as on the left side. The mortality of intrapericardial pneumonectomy is in the range of 5-10% and the complication rate is about 20%.