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 leiomyomata, or less commonly esophageal wall (bronchogenic) cysts or gastrointestinal stromal tumors, are found within the esophageal wall musculature. Endoscopic ultrasound (EUS) facilitates accurate measurement of size and is the preferred follow-up method. Leiomyomata tend to grow very slowly and often remain sta- ble for many years, but if they enlarge progressively, resection is indicated. Tumors that cause symptoms such as dysphagia are usually large (>5 cm), whereas smaller tumors are usually asymptomatic. Surgeons need to be aware that dysphagia in patients with a small tumor is often due to a different problem. Patients should undergo full cardiorespiratory evaluation, if necessary with the addition of pulmonary function testing and echocardiography.