Introduction: Thoracoscopic resection of esophageal leiomyoma is well described in the literature and is generally performed in the left lateral decubitus position. There is increasing interest in esophageal surgery utilizing the prone position and potential benefits of this technique with regard to operative time, surgeon ergonomics and operative exposure.

Methods: Our video demonstration highlights key elements of prone thoracoscopic enucleation of esophageal leiomyoma. Three ports are placed for visualization and instrumentation and low pressure insuflation with 8mmHg of CO₂ maximizes esophageal exposure. In this video we demonstrate operative technique, visualization, ease of dissection and surgical ergonomics of using this approach.

Results: Surgical exposure allowed for complete enucleation with minimal blood loss. Recovery was uneventful and complete. A single surgeon can comfortable perform this procedure without the need of skilled surgical assistant.

Conclusion: Prone thoracoscopic enucleation of esophageal leiomyoma is technically feasible and may confer advantages with regard to surgeon ergonomics and visualization.