Over the past ten years, minimally invasive thoracic surgery represented by television thoracoscopic surgery has been rapidly developed and continuously improved, and the scope of its use has been involved in various fields of thoracic surgery, and it has become one of the commonly used surgical methods in thoracic surgery. Because of its anatomical location and the specificity of its diseases, the esophagus is more suitable for thoracoscopic surgery, and at the same time, it is also an organ that is relatively difficult to carry out thoracoscopic surgery. Since 1992, when Pelligrini first successfully used TV thoracoscopic surgery for esophageal diseases, the technique has been improved day by day and has now become the first choice for the treatment of benign esophageal diseases. Thoracoscopic esophageal surgery in China started earlier, but the development is slow and very unbalanced, and the overall level is still backward. A total of 65 articles about TV thoracoscopic esophageal surgery published in China from 1994 to 2002 were retrieved by CMCC search system, which were published in 38 journals with authors from 31 hospitals in 17 provinces. Although the types of surgery included esophageal cancer and various benign esophageal diseases, the number of cases was less than 50. In addition, transperitoneal laparoscopic esophageal myotomy, hiatal hernia repair and anti-reflux surgery are very common clinical applications in developed countries, while they are rarely reported in China. It can be seen that in the field of minimally invasive esophageal surgery, we need to further improve both the types of surgery, quantity, standardization and popularity. Here, we analyze the current situation and problems of minimally invasive surgical treatment of esophageal diseases in China and put forward some immature views. 1.Benign esophageal diseases: it is the most suitable category of diseases to be treated by minimally invasive surgery. Surgical pathways mainly include thoracoscopy and laparoscopy, with small incisions in a few cases. The standard minimally invasive surgery is a standardized treatment of esophageal diseases accomplished with special surgical instruments and surgical methods under four chest wall or abdominal wall trocar incisions of about 1 cm. Esophageal smooth muscle tumors, esophageal diverticula and esophageal cysts are mainly operated thoracoscopically; there is no difference between domestic and foreign methods. For the treatment of hiatal hernia and cardia, the main procedure in China is thoracoscopy, and seldom do the anti-reflux surgery at the same time; while in foreign countries, it is basically done laparoscopically and Nissen’s anti-reflux surgery is done at the same time; obviously, the latter is more in line with the physiological characteristics, and the theoretical and clinical effect is better. In Europe and the United States, anti-reflux surgery for reflux esophagitis is a common surgical procedure in thoracic surgery, and has basically completed the process of transformation from traditional open abdominal or open thoracic surgery to laparoscopic surgery. However, this common disease has not yet received enough attention in China, which is mainly manifested in the insufficient level of awareness, backward diagnostic means, conservative treatment concepts, and incomplete treatment means. In short, there is still a big gap between us and developed countries in terms of minimally invasive treatment for benign esophageal diseases, especially for functional esophageal diseases. 2. Esophageal cancer: At present, the most commonly used surgical method at home and abroad is to perform radical resection of early and middle thoracic esophageal cancer under thoracoscopy through 4 trocar incisions of about 1.cm on the right chest wall, then change to the supine position, free the stomach by epigastric incision and lift it up to the neck, and then perform gastro-esophageal end-side anastomosis under the neck incision. In recent years, with the improvement of surgical conditions and technological progress, some people began to try thoracic and laparoscopic combined esophagectomy with intrathoracic or cervical anastomosis, which reduces epigastric trauma; although the technology is not yet fully mature, and the operation time is longer, it is still not a development direction. Thoracoscopic esophageal cancer surgery in China has been carried out earlier and has been in a leading position, but the pace of development has slowed down in recent years, and mainstream scholars have continued the traditional operation without new breakthroughs. To maintain the leading level of minimally invasive esophageal cancer surgery in China, further efforts are needed from domestic colleagues. In addition, minimally invasive treatment of esophageal cancer is still controversial, and the focus is whether it can achieve the goal of radical treatment. In our experience, for early and middle stage esophageal cancer with tumor less than 5cm and without invasion of muscular layer, esophagectomy and mediastinal lymph node dissection can be successfully accomplished by thoracoscopy; however, it is not suitable for advanced esophageal cancer with obvious external invasion. Small incision: Thoracoscopic-assisted esophageal surgery through small incision is a typical operation with Chinese characteristics; this is because no similar report has been seen in foreign journals so far. Doctors who have some experience in thoracoscopic surgery know that as long as the surgical indications are appropriate, all operations of esophageal surgery can be completed under the microscope, without the need for direct visualization or expanding the incision to obtain the specimen; only when there are comorbidities that can not be handled by the microscope or lesions that are unsuitable for thoracoscopic surgery, then we will refer to a small open thoracotomy or a conventional open thoracotomy. Therefore, thoracoscopic plus small incision esophageal surgery is not really thoracoscopic esophageal surgery (thoracoscopy), but thoracoscopy-assisted “small incision surgery”, or “intermediate small incision surgery”. However, in view of its minimally invasive characteristics, it is also categorized as minimally invasive esophageal surgery. Analyze the survival of this minimally invasive surgery in our country, there are two main factors; one is the experience of open-heart surgery in the case of thoracoscopic surgery technology has not yet been well mastered by doctors eager to carry out difficult esophageal surgery, so the “improved” surgical methods; the second is the economic conditions of the limitations of the cost of saving had to do. The former is more common. In the 65 papers we counted, a considerable portion belonged to thoracoscopy-assisted small-incision surgery. Personally, I believe that under the current conditions in our country (relatively backward economy and lack of technology promotion mechanism), this kind of minimally invasive surgery should be recognized and promoted to some extent. Although it is not thoracoscopic surgery in the true sense of the word, it does achieve minimally invasive esophageal surgery to a certain extent for the benefit of the patient; and with the accumulation of surgical experience, I believe that these surgeons will gradually go over to fully microscopic operations. Therefore, I suggest that we should face up to this procedure, and there is even less need to disguise it; because it has almost the same minimally invasive therapeutic effect as thoracoscopic surgery. We emphasize the difference mainly for conceptual rigor.