We present a case of a 74M who presented with worsening shortness of breath. The patient had as significant medical history of obstructive pulmonary disease, however due to his worsening shortness of breath he presented to the emergency room. Upon evaluation, the patient underwent a CT scan due to concern for a pulmonary embolism, and was found to have a large diaphragmatic and intercostal (between the 8^th and 9^th rib) hernia. Due to his multiple comorbidities, he was evaluated by pulmonology and was found to have a restrictive lung pattern. Due to the worsening of his symptoms and following a multidisciplinary evaluation of the patient, the decision was made to pursue a minimally invasive approach. The patient was taken to the operating room and utilizing one cameral port and two working ports, the hernia contents were reduced and the defect was partially closed primarily. After the defect was made smaller to approximately 5-6cm in diameter, a 20 x 15 cm Ventralight ST mesh was chosen. The mesh was secured along its edges with running 2-0 PDS barbed suture and also at the edges of the defect , creating a double crown effect. There was sufficient overlap. A 20F chest tube was placed. The surgery was completed and no intraoperative complications were appreciated. The patient was extubated and chest tubes were removed on POD #2. The patient was discharged to rehab given overall deconditioning. He ultimately returned to the emergency room due to a seroma which was managed expectantly.