On December 18, 2014, our department successfully completed the first thoracoscopic esophageal atresia surgery in Hubei Province, and the child is now recovering smoothly, eating normally and with normal vital signs. Esophageal atresia is a serious gastrointestinal malformation in the neonatal period, with a morbidity rate of about 1 in 3000. Due to esophageal atresia, children are unable to take milk or breast milk after birth, and often suffer from severe choking and coughing, cyanosis, respiratory distress, and in severe cases, death during the first feeding. The saliva in the child’s mouth can not be swallowed into the stomach, it accumulates in the mouth and can easily be swallowed into the lungs; esophageal atresia children often have a fistula between the esophagus and the trachea, gastric reflux is easy to get into the trachea, the above factors lead to severe inflammation of the trachea, bronchial tubes and the lungs, the respiration can not be sustained, the blood lack of oxygen, which can easily lead to the child’s death. Surgery is the only way to save the child’s life. Surgery involves reconnecting the child’s esophagus, completing the continuity of the esophagus so that saliva and food from the mouth can reach the stomach; and ligating the fistula so that air and food can go their separate ways. The traditional method is to perform open thoracic surgery, which involves large incisions, trauma and high mortality. Thoracoscopic completion of this type of surgery, technical difficulty, anesthesia difficulty, the entire surgical team is extremely demanding. It is reported that in China, thoracoscopic surgery can only be done in large children’s centers such as Beijing, Shanghai and Jiangxi. Successful completion of thoracoscopic esophageal atresia surgery involves adequate preparation in several aspects. First, preoperative airway management and systemic assessment are extremely important. Preoperative warming and continuous suctioning are required to avoid aspiration and choking and loss of surgical opportunity. It is important to maintain the stability of the internal environment and to assess the child for any other malformations. Second, the close cooperation of intraoperative anesthesia, neonates thoracic cavity volume is small, coupled with intraoperative artificial pneumothorax lung compression, the child will be hypoxic manifestations, to ensure adequate pulmonary ventilation; third, the high demand for the operator, not only need to have skillful luminal technology, but also have a variety of gastric or colonic esophageal replacement of the surgical experience to deal with a variety of unforeseen situations. Finally, there is also the careful treatment by experienced postoperative recovery management and nursing team. Wuhan Union Medical College Hospital’s pediatric laparoscopic technology started early and strong in China, and has accumulated rich experience. In the past 20 years, we have successfully treated a large number of pediatric esophageal burn stenosis and partial esophageal atresia cases by using gastric or colonic substitutive esophageal surgical techniques, and have accumulated rich open surgical experience; meanwhile, our pediatric anesthesia technology is leading, which has provided a technical guarantee for the success of this child’s surgery.