【Abstract】 Objective To explore the efficacy and safety for treat esophageal leiomyoma by video-assisted thoracoscopic surgery (VATS) with assisted gastroscope. Methods 22 patients with esophageal leiomyoma extraction were done VATS with assisted gastroscope. In operation, the gastroscope has affect of esophageal leiomyoma’s seat, examining esophageal mucosa and cracking mucosa was repaired. Results There was no operative death, serious complication and transferring open chest. Operation time was 90 minutes average. Postoperative haspital stay time was 6 days. Conclusion VATS with assisted gastroscope treating esophageal leiomyoma decreased operative trauma, quick recovery and minimal scar. In operation, the gastroscope has decisive affect at esophageal leiomyoma’s seat, examining esophageal mucosa and cracking mucosa was repaired.