Surgery is an important method for the treatment of resectable esophageal cancer. With the continuous development of minimally invasive esophageal technology, video-assisted thoracoscopic esophagectomy (VATE) has demonstrated obvious advantages over conventional open surgery and has been widely accepted. However, there are still some esophageal cancer patients who cannot benefit from VATE. Inflatable video-assisted mediastinoscopic transhiatal esophagectomy(IVMTE) does not require one-lung ventilation, reduces postoperative complications, expands surgical indications, and brings surgical opportunities for patients with impaired lung function and thoracic lesions, which has become a new choice for the treatment of esophageal cancer. However, the limited field of surgical view and the tunneling surgical approach undoubtedly increase the difficulty of surgery, and how to clearly expose the anatomical structures and thoroughly dissect the lymph nodes has always been the key points and difficulties of surgery. The authors review relevant literatures to discuss the clinical progress and limitations of IVMTE.