Traditionally esophageal leiomyoma enucleation is achieved by thoracotomy. We report a leiomyoma of the mid-esophagus swiftly and safely treated through a right thoracoscopy with the patient in prone position.

A 49 year old female consulted for solid dysphagia without other symptoms or history. The preoperative work-up showed a submucosal 50 x 28 mm leiomyoma of the mid-esophagus. The patient was placed in prone position. A 30° scope was introduced in the 7th intercostal space on the posterior axillary line. Peroperative gastroscopy permitted to localize the lesion which appeared to be situated at the level of the azygos vein. Two 5 mm trocars were inserted in the 5th and 9th intercostal spaces on one line with the first one. The azygos vein was ligated. The muscular layer was opened by coagulating hook. Thanks to a 4th 2 mm trocar-less forceps, the operative field was well exposed and the lesion was resected without opening of the mucosa. The muscular layer was closed by interrupted silk 2/0 stitches. A drain was left in the cavity.

Total operative time was 85 min and blood loss was less than 20 ml. Benign pathology was confirmed. The gastrograffin swallow on 2nd p.o. day showed good clearance of the esophagus and absence of leak; the patient was discharged on the 3rd p.o. day.

Thoracoscopy in prone position permits to reach the esophagus under excellent conditions, and the surgeon can operate in an ergonomic position. This approach allows for fewer trocars which favourably influences both hospital stay and patient's comfort.