Esophagectomy is a complex procedure that is associated with significant morbidity and mortality in even the best of hands. With the introduction and widespread application of minimally invasive techniques, the possibility of improving outcomes has been entertained. In a series of 222 patients that underwent minimally invasive esophagectomy at the University of Pittsburgh, the mortality rate was 1.4%, with major morbidity occurring in 32%. The overall spectrum of complications encountered was similar to that previously reported in the largest open series. The marked reduction in mortality and hospital stay when compared with many open series may be an important consequence of the minimally invasive approach, though prospective randomized studies will be required to further assess this potential benefit.