Position in the usual thoracotomy position, usually right side up unless abnormal location of aortic arch (RAA).
Place ports as shown, but sometimes the ports are highest ANTERIOR to the scapular edge (stab incision), middle is 5 mm port for the clip and ligasure (3 bars setting), and the lowest is a 5 mm port for the camera.
Place ports as shown:

The port (5 mm) under the border of the scapula should be positioned high – otherwise you will be sewing backwards. The lateral middle port is a stab incision for 3 mm instruments. The lower camera port is 5 mm, and the scope is 70 degree.
3-5 mm Hg of insufflation pressure is used. Left mainstem intubation is preferable if possible when using conventional mechanical ventilation, but an oscillator is much better.
Divide the azygous vein with the Ligasure(Tm).
Mobilize the esophagus in the usual fashion.
The fistula is clipped with a 5 mm clip – usually singly, but if 2 clips can be placed well, go ahead.
We use 4-0 silk or surgilon on a skiied needle, usually 8-10 cm long for the anastomosis. The needle may be a break-away.
When the anastomosis is half completed, anesthesia advances a trans-nasal silastic tube through the repair, and it is well secured. 10. The anastomosis is completed, and a 7 mm round Blake(Tm) drain is left through the lower port.
Feedings can be started in 2-3 days via the trans-anastomotic tube.
A contrast study is obtained in 7 days to check the anastomosis.
Final result: