Objective: To explore the method and effect of video-assisted thoracoscopy and hand-assisted video-thoracoscopy for resection of esophageal cancer. Method: Fifty-one patients with mid-esophageal cancer underwent video-thoracoscopic esophagectomy through cervical esophagogastric anastomosis. Fifteen patients from them received thoracoscopy surgery to dissect esophagus, then gastric tube was made by laparotomy, and anastomosis was made in the neck. The other 36 patients received hand-assisted video-thoracoscopy, first of all the gastric tube was made by laparotomy, the dissection of esophagus was performed with the assiatance of hand to press down the lung,and the anastomosis was made in the neck.Results: The mean operative time of video-thoracoscopic esophagectomy was 200 min, and of hand-assisted video-thoracoscopy was 160 min. All patients' surgery and postoperative recovery were successfully with no anastomotic stricture. One patient who received hand-assisted video-thoracoscopy had cervical anastomotic fistula, which healed by dressing change through the neck incision. There was no perioperative mortality. Conclusion: It is suggeste that the outcome of video-assisted thoracoscopic resection of esophageal cancer is same as routine thoracic operation, with the advancements of shorter operative time, minimal invasion, less complications and quick recovery.