A 58 year old woman presented with 1 year history of progressive dysphagia but without weight loss. Numerous investigations (contrast UGI, CT scan, and EUS) at the referring institution suggested a mid-esophageal benign leiomyoma. Two endoscopic biopsies performed prior to referral were non-diagnostic. The consenting patient was brought to the operating theatre with a presumptive diagnosis of esophageal leiomyoma. After endotracheal intubation with a single lumen tube, the patient was placed in the left lateral decubitus position. One 12 mm and three 5 mm ports were placed, CO2 pneumothorax was generated to 10 mm Hg. After division of the azygous vein, the mid-esophagus was fully mobilized. Using ultrasonic shears, a 5 cm myotomy over the area of the tumor was developed. The mass was then enucleated without injury to the mucosa despite the adhesions induced by the prior biopsies. The myotomy was closed with interrupted sutures tied extra-corporeally. After removal of the tumor mucosal integrity was confirmed endoscopically. The pneumothorax was released and incisions closed without a chest tube. A contrast esophagram obtained on POD #1 failed to demonstrate a leak and the patient was discharged on POD #3 on a regular diet. Final pathology confirmed the diagnosis of benign leiomyoma.