Video thoracoscopy allowed epiphrenic esophageal diverticulectomy through a right approach. Six patients were treated through November 1992. Three to four trocars were inserted to isolate and staple the diverticulum under intraoperative esophagoscopic control. Four patients with manometric LES abnormalities underwent preoperative dilation of the cardia. One leak from the staple line occurred and required thoracotomy. Six-month follow-up shows relief from symptoms and no pathologic refluxes on 24-hour pH monitoring.