Surgical enucleation of submucosal tumors of the esophagus (mostly leiomyomas) is indicated when either the tumors are symptomatic or their biological behavior is unclear. The classic approach is a thoracotomy, but tumor enucleation can now also be performed via thoracoscopy.

Our approach of choice is right video-assisted thoracoscopic surgery (VATS) for tumors of the thoracic esophagus. The mediastinal pleura over the tumor was longitudinally opened by Ultrasound Scalpel (US). The azygos vein lying over the tumor was divided by means of US and absorbable clips. The muscular layer of the esophagus was also longitudinally opened. The tumor was enucleated. Simultaneous intraoperative esophagoscopy was performed.

The postoperative course was uneventful.

Minimally invasive approaches are suitable for the surgical enucleation of submucosal esophageal tumors. The advantages of the thoracoscopic surgery are as follows: rapid, full recovery of the patient; decreased postoperative pain; short postoperative hospital stay. Thoracoscopic and laparoscopic techniques are recommended as standard procedures in experienced centers.