We report our initial experience with thoracoscopic assisted esophagectomy (TAE) in patients with esophageal carcinoma. Clinical outcome measures are reported for 14 consecutive patients who underwent thoracoscopically assisted esophagectomy at our institution between January 2007 and June 2009. These outcomes were compared with 18 patients who underwent open esophagectomy (OE) during this time. All 14 patients were male, with a median age of 63. All had distal esophageal adenocarcinoma: stage I (7), II A (2), II B (3), and III (2). Surgical approaches included laparotomy combined with thoracoscopy and cervical (n=12), or intrathoracic anastomosis (n=2). Compared with an open approach, the thoracoscopic assisted esophagectomies were longer (median time 460 vs. 386 minutes), and they were associated with less blood loss (250 mL vs. 500 mL) and less respiratory complications (14.3% vs. 27.8%). In our TAE group more lymph nodes were removed (median number 12 in TAE vs. 10 in OE). The overall morbidity was similar in both groups (42.8% in TAE vs. 50% in OE group), but the in-hospital mortality was reduced with TAE (7.1% with TAE vs. 16.7% with OE). TAE is feasible with a low conversion rate, acceptable morbidity, and low mortality.