Thoracoscopy is an excellent means for staging esophageal cancer. Staging of esophageal carcinoma facilitates prognostication and allocation of patients to appropriate treatment regimens. Thoracoscopy is also useful in biopsies of direct mediastinal invasion. Routine thoracoscopic and laparoscopic lymph node staging has been used in patients with esophageal carcinoma with excellent results. Thoracoscopy can allocate patients for neoadjuvant therapy and help avoid an unnecessary thoracotomy in patients found to have gross spread of locoregional disease.