The application of minimally invasive surgical techniques continues to evolve. Benign tumors of the esophagus are rare lesions that constitute less than 1% of esophageal neoplasms. Nearly two thirds of benign esophageal tumors are leiomyomas. Surgical excision is recommended for symptomatic leiomyomas and those greater than 5 cm. In this video, we describe a minimally invasive thoracoscopic enculeation of an esophageal leiomyoma at the level of the azygous vein while avoiding the morbidity of a traditional thoracotomy.

Our case involves a 46 year old caucasian male with history of gastroesophageal reflux complaining of dysphagia who was evaluated with endoscopic ultrasound illustrating a 3 cm subepithelial lesion 25 cm from his incisors. The lesion was anechoic, without nodularity or compartments consistent with an esophageal leiomyoma. Fine needle aspirate was indeterminate for malignancy and a positron emission tomography test showed no areas of uptake.

Patient had an uneventful minimally invasive thoracoscopic esophageal leiomyoma enculeation. He had a normal swallow study post operative day one and was discharged home eating a regular diet post operative day three. He had complete resolution of his dysphagia symptoms.

Minimally invasive thoracoscopic enculeation of benign esophageal lesions is a safe approach that can avoid the morbidity associated with traditional thoracotomy enucleation.