For smaller esophageal smooth muscle tumors, we use endoscopic EMR or ESD techniques. For larger esophageal smooth muscle tumors from the intrinsic muscular layer (some are mesenchymal tumors), in order to avoid complications such as perforation and bleeding, we use combined thoracoscopic + gastroscopic esophageal smooth muscle tumor resection, using a special lumpectomy suture, ENDOSTICH, to close the esophageal muscular layer and epithelium. Advantages: the operation can be completed with three small incisions of 1 cm and one of 5 mm in the chest wall, aesthetic, less painful, quick recovery and short hospital stay (3-5 days after the operation), and we have already removed a 6 cm smooth muscle tumor.