Background <p>Thoracoscopic repair of esophageal atresia with tracheoesophageal fistula (EA/TEF) offers the advantages of minimally invasive surgery, but is technically demanding with a steep learning curve. This study outlines a 5-year evolution of the surgical technique and perioperative practices in a resource-limited setting, highlighting adaptations that improved outcomes.</p> Methods <p>A retrospective observational study was done to include type C EA/TEF patients who underwent attempted thoracoscopic repair at our centre from January 2019 to December 2024. An analysis of operative videos, records, and outcomes was conducted, focusing on evolving techniques, anaesthesia protocols, and intraoperative strategies. Data obtained included gestational age, associated anomalies, anaesthetic approach, patient positioning, use of Fogarty catheter, number and size of ports used, azygos vein management, method of fistula ligation, type of esophageal anastomosis, conversion to open repair, anastomotic leaks, and mortality.</p> Results <p>Thirty-three neonates underwent attempted thoracoscopic repair, of which 25 had successful primary repair. Eight required conversions to open surgery, which were mostly done in the initial phase of our learning curve. Continuous evolution led to several technical modifications, including a shift from single-lung ventilation (SLV) to double-lung ventilation (DLV), lateral to semi-prone positioning, fistula ligation with polymer clips, azygos vein preservation and others, which will be discussed. The overall mortality was 28%.</p> Conclusion <p>Thoracoscopic EA/TEF repair is feasible in resource-limited settings with structured technical refinement and dedicated team training. This study provides a pictorially documented roadmap for centres beginning this complex procedure, emphasising the role of institutional commitment and continuous evaluation in achieving favourable outcomes.</p> Graphical abstract <p></p>