This report describes the treatment of a descending thoracic aortic aneurysm with an endograft introduced through the infrarenal aorta by using the laparoscopic technique. The indication for infrarenal aorta access was the existence of heavy calcifications and stenosis of the both iliac arteries. We report what we think to be the first totally laparoscopic assisted thoracic aorta endograft delivery by direct sheath placement into the aorta.