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Introduction Video assisted thoracoscopic surgery of esophagus (VATS-E) is generally performed in left lateral position in Japan because esophagectomy and lymph adenectomy are done as the open method. Recently, VATS-E in prone position is remarkable in Japan because the lung moves below by the gravity, and a good operative field is obtained. We introduce our methods and devices perfomed in prone position at our hospitalPatients Twenty patients in left lateral position and 15 patients in prone position, with esophageal squamous cell carcinomas underwent VATS-E since 2005 and 2009, respectively. Methods At first the patients are fixed at semi-prone position because both prone and left lateral positions can be set by rotating. Four 10 mm ports are used at the 3rd, 5 th, 7th and 9th, and mini-thoracotomy incision of 3.5 cm is made at the 5th intercostal space (ICS). The pneumothorax by maintaining CO2 insufflation pressure of 6 mmHg is made, and esophagectomy is performed in prone position. The lymph nodes around the trachea and bronchus, above the diaphragm and along the bilateral recurrent laryngeal nerves are dissected. The sponge spacer is used to mobilize the esophagus, rotate the trachea and aspirate blood. Working space at the lower mediastinal area is obtained by retracting the esophagus using the retractor or sponge spacer , and at the left upper mediastinal area is obtained is obtained by stripping the residual esophagus and retracting the trachea using the retractor. Results 1. Mean estimated blood loss was 174 ml of chest procedure in prone position. 2. The rate of recurrent laryngeal nerve paralysis was 13.3% (2/15), and anastomotic leak was 8.9%(1/15). 3. There was no incidence of conversion to open method, and of postoperative pneumonia. 4. Lymphadenectomy along the left recurrent laryngeal nerve was nearly done in prone position in the late term. 5. The sponge spacer is available for VATS-E. Conclusion 1. VATS-E in prone position is a simple and feasible method. 2. Safe VATS-E is facilitated by putting the patient in the semi-prone position, using the mini-thoracotomy procedure and using a sponge-spacer.