This patient is a 54 year old male who presented with a long history of gastroesophageal reflux. He underwent endoscopic surveillance and was found to have a nodule at thirty-seven centimeters from the incisors. Biopsy of the nodule demonstrated it to be moderately differentiated intramucosal adenocarcinoma. Our plan was to perform laparoscopic and thoracoscopic Ivor-Lewis esophagectomy. After placement of a jejunostomy feeding tube the hepatogastric ligament was divided and the lesser sac was entered. The left gastric vessel was isolated and divided with an Endo GIA stapler. The the greater curvature of the stomach was entirely mobilized while preserving the right gastroepiploic arcade. The gastric conduit was created by applying the linear stapler along the lesser curvature of the stomach all the way up to the Angle of His. Once the conduit was completely transected away from the surgical speciman, the tip of the gastric conduit was then sutured to the surgical specimen in preparation for a gastric pull-up. We then proceeded to mobilize both the left and right crus of the diaphragm and the distal esophagus in the mediastinum. At this point the patient was repositioned in the left later decubitus position and the thoracoscopic portion of the operation started. We mobilized the esophagus by dividing the mediastinal pleura overlying the esophagus from the hiatus up to the level of the azygous vein. The Endo GIA stapler was used to divide the azygous vein. The esophagus was divided at the level of the azygous vein by harmonic scalpel. The anvil was placed into the esophageal stump. The 25-mm EEA stapling device was placed through a gastrotomy into the stomach and an esophagogastric anastamosis was created. A 28-French chest tube was then placed into the chest cavity and all ports were removed. Pathology revealed intramucosal well differentiated adenocarcinoma of the esophagus with sixteen lymph nodes negative for malignancy.