In comparative studies, thoracoscopic repair of esophageal atresia (EA)/tracheoesophageal fistula (TEF) is safe compared to thoracotomy with no increase in the complications of anastomotic leak or stricture. However, the selection criteria for this approach were not universally defined. We reviewed the literature and found, based on the exclusion criteria of the studies reviewed as well as the population characteristics of those who underwent thoracoscopic repair, that thoracoscopy is safe in those with birth weight > 2 kg, gestational age > 37w, and no severe cardiac or chromosomal anomalies. Thoracoscopic EA/TEF repair is technically challenging with a steep learning curve. We found data to suggest that the learning curve starts to plateau after at least 10 cases with an associated decreased operative time. Given the challenges around volume and individual surgeon experience, we recommend mentorship and simulation to aid in obtaining proficiency.