A 64-year-old woman with a history of total gastrectomy for gastric cancer present with a benign esophagojejunal stenosis. Electively is programmed for a endoscopic dilation of the stenosis. During the endoscopic dilatation she has an a distal esophageal perforation recognized during the procedure and is immediately taken to the OR. With the patient in prone position , thoracoscopy is performed through the fifth intercostal space of the left hemithorax with posterior axillary line. Mediastinal hematoma related to esophageal perforation is observed. Under direct vision two additional operator trocars are introduced, one below the scapula and another in the seventh intercostal space with anterior axillary line. The mediastinal pleura is incised with harmonic immediately anterior to the aorta in order to expose the distal thoracic esophagus. The inferior pulmonary ligament is sectioned. We identify the vagus nerve. With a intraoperative endoscopy the esophageal perforation area is identified observing bubbles with the endoscopic insufflation . The proximal and distal esophagus are dissected until accurate identification of the perforation site is obtained. Identifying the esophageal edges, a suture is carried out with PDS 00 suture with interrupted stitches. Endoscopy is passed to check the integrity of the repair. A postoperative esophagogram was made at 7 post-operative day and the patient was discharged a day later without complications.