Since esophageal cancer is prone to lymph node metastasis, which affects the patient’s prognosis, lymph node dissection for surgically resectable esophageal cancer is very important. Currently, all esophageal cancer surgeries require open-heart surgery, which increases the risk of pulmonary and cardiac complications. Previously, esophageal dissection for some patients with early-stage esophageal cancer or poor cardiopulmonary function and no clinical lymph node metastasis in the chest could reduce cardiopulmonary complications, but the risk of lymph node metastasis in the chest increased due to the inability to clear the lymph nodes in the chest. Based on more than 10 years of proficiency in mediastinoscopic techniques, our medical group has carried out mediastinoscopic-assisted transjugular and transesophageal fissure esophageal cancer radical resection. This procedure not only opens up the chest, reduces cardiopulmonary complications and pain, but also clears the lymph nodes in the chest and reduces recurrence, thus improving the prognosis.