Standard workflow for the Watchman FLX left atrial appendage (LAA) occlusion device requires both transesophageal echocardiography(TEE) and fluoroscopy(FL). To demonstrate the Watchman FLX has unique characteristics which permit additional evolution of the implant protocol including the elimination of ionizing radiation, contrast dye, and lead aprons. Consecutive patients (n=12) were implanted with a FLX device at 2 US centers using a workflow modification to allow no FL throughout the entire procedure. To facilitate echocardiographic visualization of the moment the FLX was aligned with the tip of the Watchman Access System sheath (WAS), the standard protocol was modified. Rather than advancing only to the radiopaque marker band prior to insertion, the FLX was advanced flush to the tip, past the radiopaque marker band. Once inserted into the WAS, the deployment knob was used to advance the Watchman 2-3 mm so that the FLX was partially deployed inside the sheath. As a result, upon alignment of the FLX with the sheath's tip it was echogenic allowing confirmation without FL. TEE was then used to visualize unsheathing the FLX within the LAA. Patients were 58% male (n=7) with mean age of 78(±5), CHADS-VASC 4(±1), and HAS-BLED 3(±1). Fluoroscopy time, time in lead, and contrast use were zero. Same day discharge was successful in 67%(n=8). 67% (n=8) were taking Direct Oral Anticoagulant (DOAC) or warfarin prior to procedure and of these 88% (n=7) were uninterrupted on the day of procedure. 33% (4/12) were either on Dual Antiplatelet Therapy (DAPT) or not on any anticoagulation preoperatively and all 4 of these were discharged on DAPT. Total time in the procedure room was 67 (±22) minutes with 51(±22) minutes of anesthesia time. A single device was used in 92% (n=11). The mean LAA maximum size was 19 (±3) mm with least device compression 20% (±9). There were no complications. No patients had a peri-device leak at implant. One patient refused TEE at follow up. At follow-up imaging at least 45 days later there were no leaks >5mm with 91% (10/11) having no leak and 1 patient having a 4mm leak. Zero fluoroscopy TEE guided Watchman FLX implantation is feasible and safe with no perceptible decrease in efficiency.