Recently, thoracic epidural anesthesia (TEA) has been employed to perform awake thoracic surgery procedures. This is the first report that describes an awake endoscopic thymectomy through an infrasternal approach using sternal lifting. This procedure allows the patient to eat, drink, and walk on the day of surgery. TEA can also be used for postoperative analgesia. Our experiences have shown that it is safe and beneficial to apply this procedure.