On the grounds of literature data and personal experience the authors evaluate manual transhiatal esophagectomy and suggest instrumental removal of the esophagus as a possible alternative. Experimental studies performed on 34 cadavers provide evidence that the topographic-anatomical properties of the esophagus allow it to be everted on a probe blindly without opening the thoracic cavity if its wall is not involved in the pathological process. This can be carried out either through the abdomen, i.e. "downwards" or through the mouth, i.e. "upwards" in which case the first method is preferable. The first successful clinical experience in transhiatal instrumental esophagectomy in 3 patients with cardio-esophageal carcinoma provides evidence of its advantages over manual esophagectomy and justifies its further use and study.