To investigate the feasibility of video-assisted thoracoscopic surgery in the treatment of esophageal leiomyoma.Clinical data of 83 patients with esophageal leiomyoma from December 2002 to August 2012 treated by video-assisted thoracoscopic surgery were retrospectively analyzed.Video-assisted thoracoscopic leiomyoma enucleations were performed in 82 patients. One patient was converted to thoracotomy to repair the esophageal mucosa and two patients required intraoperative mucosal repair by video-assisted thoracoscopic surgery for esophageal mucosa rupture. The mean operative time was 83.0 min (range, 40-300 min), and the mean blood loss was 52.4 ml (range, 20-150 ml). The mean length of postoperative hospital stay was 5.8 d (range, 3-50 d). The mean tumor diameter was 3.3 cm (range, 0.8-12.0 cm). One case with postoperative esophageal fistula was cured by conservative treatment. Eighty patients were followed up for 2-117 months, and all the patients were free of dysphagia without recurrence or other related complications.Thoracoscopic enucleation of esophageal leiomyoma can be performed effectively and safely. Thoracoscopic techniques for the removal of larger esophageal leiomyoma may be recommended as the treatment of choice in centers experienced with minimally invasive surgery.