We treated four cases of thoracoscopic enucleation of esophageal leiomyoma. All four cases were asymptomatic, but either barium swallow or esophagofiberscopic examination revealed esophageal submucosal tumor. The locations of the tumors were middle and lower in one case and middle in the other three cases. All patients were intubated with a double lumen endotracheal tube under general anesthesia. Two patients required thoracotomy due to the tumor surrounding the esophageal wall in one case and severe adhesion to the esophageal mucosa in the other. The mini-thoracotomy was used in three cases. In the other two cases, we used four and three trocars, respectively. The balloon catheter, which had been inserted into the esophageal lumen, was useful for removing the tumor. The tumor was pulled up using the traction suture and dissected from the mucosa and muscular layer. After enucleation of the leiomyoma, the split muscular layer was sutured. The postoperative course was uneventful. These two patients were discharged on the 12th and 15th postoperative days, respectively. We conclude that the thoracoscopic enucleation of the esophageal leiomyoma is useful for reduction of surgical stress and is a more feasible approach for the treatment of esophageal leiomyoma.