There has been a recent trend to approach complex disease at the hiatus robotically or endoscopically instead of laparoscopically. This video demonstrates that a laparoscopic approach can be safely and efficaciously used to resect a submucosal tumor just above the gastro-esophageal junction. The patient in the video had a Roux-en-y Gastric Bypass in the distant past that was revised because of a refractory ulcer and hiatal hernia. She recently developed dysphagia and was found to have a submucosal tumor at the GE junction and a recurrent hiatal hernia. The video illustrates the laparoscopic approach used to the resect the tumor and repair the hernia. The use of simultaneous upper endoscopy is also demonstrated in the video. The video points out the complexity of the problem as well as methods used to secure a safe resection while using only traditional laparoscopic techniques. Included in the video are the patient's upper gastrointestinal series and upper endoscopy done as part of her work up. Her pathology is presented and confirmed the pre-op diagnosis of a benign leiomyoma. The patient was hospitalized for 24 hours, advanced to a regular diet over a two week period, and remains symptom-free.