Laparoscopic surgery offers distinct advantages to traditional surgery, including decreased hospitalization and recovery periods, decreased postoperative discomfort, and improved cosmesis. A feasible laparoscopic approach to the treatment of peptic ulcer disease might confer similar patient benefits. A modified highly selective vagotomy (in combination with cholecystectomy for symptomatic cholelithiasis) has been successfully completed under laparoscopic guidance in a patient with intractable ulcer disease. The patient was discharged on the second postoperative day, tolerating a regular diet. The patient's dyspeptic symptoms disappeared during the immediate postoperative period and further endoscopic evaluation revealed resolution of active ulcer disease. Although experience is still limited in the United States, initial clinical results from Europe would indicate that laparoscopic vagotomy is not only feasible but effective. With further experience, laparoscopic vagotomy may provide a viable alternative to the standard treatment of peptic ulcer disease.