Objective: Non-intubated video-assisted thoracoscopic surgery (NI-VATS) with sedoanalgesia is commonly used and became an increasingly popular surgical technique for minimal invasive procedures in the last decade. In this study it is aimed to present the usage of the awake video-assisted thoracic surgery (A-VATS) technique with pure local anesthesia without sedation or thoracic epidural anesthesia. Material and Methods: Between 2009 and 2019, 43 patients who underwent awake video-assisted thoracoscopic surgery were evaluated retrospectively. Patients who classified as high risk for general anesthetic were included in the study. In this VATS technique, after the skin preparation, 10 ml 0.5% bupivacaine with 10 ml saline was administered subcutaneously and intramuscularly. 15 minutes later, a single port incision was made to the thorax for 10-mm 0-degree single-puncture videothoracoscope. Age, sex, complaints, laterality, type of effusion, cytology results, comorbidities of patients, length of hospital stay, amount of drained effusion, operation time, and pathology results were evaluated retrospectively. Results: Forty-three patients (23 male, 20 female) were evaluated. The mean age was 67.32 (45–85) years. The dominant complaint (n = 40) was dyspnea. A-VATS was performed on 22 left and 21 right sides. There was 39 patients with hydrothorax, 4 with pneumothorax. The mean total fluid discharged by patients with hydrothorax was 1311 ml (400–4000 ml). A-VATS wedge resection was performed for 2 patients because of pneumothorax due to bullae. Conclusion: A-VATS is a safer technique in selected patients because it does not require muscle relaxants and sedatives.