Hippocrates (c. 460-377, Ancient Greece, founder of Western medicine): Medical interventions should be, first and foremost, as non-invasive as possible; otherwise the effect of treatment can be worse than the natural course of the disease. Minimally invasive cardiac surgery (MICS) is a new clinical concept introduced in the late 1990s with the aim of reducing surgical trauma, accelerating patient recovery, shortening hospitalization time, and reducing health care costs.MICS is in fact an integral part of minimally invasive surgery, whose techniques include laparoscopy, interventional radiology, interventional ultrasound, and small-incision direct visualization. MICS is actually a component of minimally invasive surgery, and its techniques include laparoscopy, interventional radiology, interventional ultrasound, and small-incision, direct-view surgery. Modern cardiac surgery took shape in the late 1970s with the establishment of extracorporeal circulation and myocardial protection. Currently, successful MICS techniques include the following: 1. Small-incision cardiac surgery: these incisions can maintain the integrity of the thorax, with less bleeding, and in female patients the incision is more hidden, but there are considerable shortcomings, including: aortic cannulation is difficult, and in the event of an accident the femoral artery needs to be cannulated immediately, the aortic valve is poorly exposed, and the surgical operation compresses the right lung and single-lung ventilation to the right lung. The right lung and one-lung ventilation have a certain impact on lung function. The advantages of small-incision cardiac surgery in terms of postoperative scar aesthetics are obvious, and small incisions can be significantly less traumatic, but it has also been argued that, although the reduction in incision may reduce some injury, the need for additional traction and the prolonged operative time due to poor visualization of the small incision may increase the degree of trauma. Smaller incisions do not necessarily mean less trauma. It is extremely unwise to risk poor visualization of the surgical field in order to perform a low-quality cardiac surgery simply for the sake of the aesthetics of the surgical incision. At present, small incision surgery is mainly used in some simple congenital heart disease correction, and small incision valve surgery has also been carried out. 2. Television thoracoscopy (VAST)-assisted cardiac surgery: VAST cardiac surgery can provide a good field of vision and improve the visualization effect that is impaired by the shortened length of the incision.The application of VAST can minimize the length of the incision. Compared to the lateral incision, the VAST cardiac incision is further reduced to 4-6 cm, which has been referred to as a window incision, a “keyhole” procedure. The successful performance of this procedure is based not only on the development of thoracoscopic techniques, but also on the development of an important extracorporeal circulation technique, the closed extracorporeal circulation technique. This is a catheterization system that establishes extracorporeal circulation through peripheral vessels (femoral artery and vein puncture cannulae) and allows for blockade of the ascending aorta, perfusion of cardiac arrest fluids, and intracardiac drainage.The use of VAST in cardiac surgery began in the early 1990s, and over the past two decades, its advantages have gradually emerged, with significant advantages in terms of trauma, recovery, complications, and postoperative cosmetic outcome, and it is now becoming an important tool in the minimally invasive treatment of cardiac disease. Minimally invasive treatment of heart disease is one of the most important means. VAST cardiac surgery requires a certain amount of technical support, including not only instruments and equipment and the establishment of closed extracorporeal circulation, but also emergency treatment plans in case of emergencies. Emergency treatment plan in case of emergency, this is because of the existence of these problems, which makes it difficult to carry out this type of surgery, at present, the domestic units to carry out this type of surgery is still very limited. Some people believe that the three-hole total thoracoscopic cardiac surgery on the right side of the chest wall has been widely attempted, and the technology has been relatively mature and can partially replace the traditional surgery to become the standard procedure. Although total thoracoscopic cardiac surgery has many advantages, it should also be seen that, for the cardiac surgeon, the laparoscopic surgery is a brand new technology, and the prerequisite is to have a good foundation of traditional cardiac surgery, and the total thoracoscopic cardiac surgery has its own special requirements. Total thoracoscopic cardiac surgery has its own special requirements, and a long learning curve is its disadvantage. Combined with the allocation of domestic medical resources and limited cardiac surgery foundation, the promotion of total thoracoscopic cardiac surgery has been restricted to a certain extent, but the advent of the real era of total thoracoscopy can not be stopped. 3.Robotic cardiac surgery: robotic cardiac surgery realizes direct visualization of the heart without opening the chest, minimizing the trauma to the patient. Moreover, the heart surgery is completed more accurately and efficiently, which is of great significance in the field of cardiac surgery. The latest four-arm da Vinci S robotic system (IntuitiveSurgical) is used. da Vinci S consists of three parts: the surgeon’s console, the bedside robotic arm tower, and the video system. The surgeon is able to maneuver the machine to perform surgery from a long distance, and the robotic arm increases the freedom of movement, greatly improving the surgeon’s ability to perform a variety of difficult maneuvers and greatly increasing the scope of surgical coverage. However, the lack of haptic feedback system is a major defect of robotic surgery, and robotic assisted system is only in a limited number of surgeries to achieve the goal of not opening the chest, the device makes the surgery time significantly longer, the cost increases. Although the current results of robotic cardiac surgery can not yet be compared with traditional cardiac surgery, but its potential advantages make this field is experiencing unprecedented development. 4, non-stop heart surgery: the most successful application of non-corporeal circulation surgery is in the application of coronary artery bypass surgery, this surgery has a history of many years, and in recent years the application of a variety of immobilizers, so that the operation is more safe and practical. In addition to being less invasive and quicker to recover than traditional bypass surgery, this approach is more suitable for patients with 2 bypass operations and contraindications to extracorporeal circulation, whereas non-extracorporeal circulation surgery is not yet practical for other intracardiac direct vision procedures. It is worth noting that when there is a drop in intraoperative blood pressure, temperature, arrhythmia, inability to determine whether it is safe to block the coronary arteries, or even intraoperative myocardial infarction should be actively dealt with, whether or not it is needed, the pre-emergency program and standby team of extracorporeal circulation is an indispensable part of the safety of the operation. 5, the application of interventional methods in cardiac surgery for the treatment of heart disease, the efficacy of surgery is reliable and consolidated, but relatively less traumatic intervention under the treatment is undoubtedly. Over the past decade percutaneous coronary intervention (percutaneous coronary intervention, PCI) has made great progress, but there are still some limitations in the treatment can be complementary to surgery, the so-called hybridization of surgery. In order to reduce the trauma of multiple surgeries and to overcome the disadvantage of difficult delivery of interventional devices, a blocker or dilatation balloon is inserted through the transatrial or right ventricular outflow tract pathway after the chest is opened and a “one-stop” surgical correction is performed for the combined cardiac malformations. The core concept of this “one-stop” hybrid procedure is that the surgeon performs the correction of the intracardiac abnormality with real-time imaging guidance using interventional devices in the beating heart after the opening of the chest, while other additional procedures are performed using conventional cardiac surgical techniques. Post-open-heart “one-stop” hybridization combines the advantages of both interventional and surgical techniques, and the results are so favorable that it will be one of the main directions in the future development of minimally invasive cardiac surgery.