Abstract
Since its inception more than a quarter of a century ago, minimally invasive cardiac surgery has attracted the increasing interest of cardiac surgeons worldwide. The need to surgically treat patients with smaller and better-tolerated incisions coupled with high-quality clinical outcomes, particularly in structural heart disease, has become imperative to keep pace with the evolution of transcatheter valve implantation. We have learned numerous lessons from our longstanding experience in this field of surgical care, especially in terms of endoscopic access via mini-thoracotomy. To improve the safety and efficacy of this minimally invasive endoscopic access, this study summarizes and highlights the lessons we have learned, acting as a template for newly established cardiac surgeons in minimally invasive techniques.