Thoracoscopic surgery has been utilized for both esophageal benign lesions and malignant lesions. Resection of submucosal and mural benign lesions, as well as Heller Myotomy, are prime indications for the procedure. Resection of or staging procedures have been performed by various centers around the world for esophageal carcinoma. Resection of epiphrenic diverticula and performance of antireflux endoscopic surgical procedures are indications for the VATS procedure. Transthoracic thoracoscopic vagectomy has been performed for a number of years. Avoidance of perforation of the esophageal mucosa and subsequent leakage are prime concerns of thoracoscopic video assisted surgery on the esophagus.