The application of thoracoscopic techniques to the excision of benign esophageal lesions provides a minimal access approach to these lesions that avoids the need for an open thoracotomy incision. Benign esophageal lesions, which are usually leio- myomata, or less commonly esophageal wall (bronchogenic) cysts or gastrointestinal stromal tumors, are found within the esophageal wall musculature. In the case of leiomyoma, the tumor can at times be densely adherent to the underlying esophageal mucosa. Thoracoscopic excision entails dissect- ing the tumor from the surrounding esophageal wall muscle, while at the same time taking care to avoid opening the mucosa if possible. As this is not always feasible, the mucosa, if breached, can be repaired by thoracoscopic suturing.