Recently, several major thoracic procedures performed in awake patients have been reported. In order to reduce the adverse effects of general anesthesia and the cost, Thoracic Epidural Anesthesia (TEA) has been employed to perform such awake thoracic surgery procedures. Awake procedure under TEA can be performed even in endoscopic thymectomy. The postoperative recovery is fast, and surgery can be performed on patients in whom general anesthesia is difficult. Herein we discuss awake thymectomy procedure and perioperative management for patients and describe the techniques in detail.