The concept of minimally invasive surgery has gradually emerged since 1987, when French doctors developed laparoscopic techniques. Minimally invasive surgery is compared to traditional surgery. The concept of minimally invasive surgery has profoundly influenced the fundamental philosophy of surgery and permeated various specific specialties of surgery. Minimally Invasive Cardiac Surgery (MICS) is actually a component of minimally invasive surgery, and minimally invasive cardiac surgery reduces surgical trauma in 2 main aspects: 1. Minimally Invasive Cardiac Surgery (MICS) is actually a component of Minimally Invasive Surgery. Minimally invasive cardiac surgery is the replacement of extracorporeal circulation with special equipment and techniques that eliminate the damage caused by extracorporeal circulation, such as non-stop coronary artery bypass grafting. 2. For example, the traditional median sternotomy is not used but replaced by various types of partial sternotomy and small lateral open incisions. Minimally invasive is the direction of cardiac surgery efforts to develop, but also the requirements of the development of the times. However, it must be soberly recognized that: 1. the technical difficulty of small incision surgery increases due to the limitation of visual field and operation space, thus the standard treatment principles may be “discounted”, such as abandoning valve repair and replacing it with valve replacement, abandoning ablation of combined atrial fibrillation, etc. 2. a certain degree of safety is sacrificed. 3. the long-term efficacy is not The long-term efficacy is not very precise and needs to be further verified. The future of minimally invasive techniques is not necessarily small incision, thoracoscopy or robotics, because these techniques are limited to the improvement of surgical access. Instead, the direction of minimally invasive techniques should be revolutionary changes and developments, such as percutaneous valve replacement, percutaneous valve repair techniques, etc. The development of small incision cardiac surgery is necessary, but it should be clearly understood that this technology is only suitable for some diseases and some patients. I. Minimally invasive coronary artery bypass grafting in the late 1950s before extracorporeal circulation technology was widely used, coronary surgery including coronary artery endarterectomy, coronary artery segmental resection, coronary artery bypass grafting with the saphenous vein and internal mammary artery as grafts was performed on a beating heart. 1967 Kolessov in the beating heart without extracorporeal circulation will be left internal thoracic artery for anastomosis with the anterior descending branch. However, early nonstop coronary artery bypass grafting encountered three difficulties: first, the movement of the target vessel interfered with precise vascular anastomosis; second, blood from the collateral circulation affected the operative field; and third, hemodynamic instability when the heart was lifted for bottom vessel anastomosis. The invention of the artificial heart-lung machine and the study of crystalloid cold-stop myocardial protection allowed cardiac surgeons to perform intracardiac operations and coronary artery bypass surgery in a resting, floppy, bloodless environment. 1967 Favaloro’s successful application of the saphenous vein for aorto-right coronary artery bypass surgery laid the foundation for modern coronary artery bypass surgery, making extracorporeal circulation cardiac cold-stop coronary artery bypass surgery a safe and easy procedure in the heart go In the 1980s, Benett et al [1] successfully performed Off-Pump coronary artery bypass (OPCAB) in South America and gained clinical experience of 1000 cases. Since then, minimally invasive coronary artery bypass surgery has attracted more and more attention from cardiac surgeons and has promoted the development of surgical techniques and devices in this field. However, it is worth noting that since conventional coronary artery bypass grafting has become very mature, in comparison, the stop-and-go coronary artery bypass graft anastomosis is more reliable and the extracorporeal circulation time is not as long, therefore, most cardiac surgeons in the United States still choose stop-and-go bypass grafting, and only a small number of them choose non-stop bypass grafting. In theory, all patients are suitable for minimally invasive coronary artery bypass grafting, especially for high-risk patients with extracorporeal circulation such as advanced age (R70 years), low cardiac function (EFQ 40%), poor liver and kidney function, chronic obstructive pulmonary disease, ascending aortic calcification, bleeding tendency, post-stroke sequelae, and reoperation. Non-extracorporeal cardiac nonstop coronary artery bypass grafting can be attempted in patients with simple coronary artery bypass grafting, i.e., without concurrent ventriculotomy, mitral valvuloplasty, or ventricular septal perforation repair.OPCAB is indicated for multiple vascular lesions, including anterior descending, gyral, and posterior descending branches. Minimally invasive coronary artery bypass grafting can achieve the same outcomes as conventional coronary artery bypass grafting, but with slightly faster patient recovery and less bleeding transfusion after the procedure [2]. Due to the progressive aging of the population, the incidence of coronary heart disease is increasing year by year and will become the leading cause of death in both developed and developing countries. The age of the coronary population is rising, along with other diseases, and many patients become high-risk patients for extracorporeal circulation, such as reoperation, advanced age, left ventricular insufficiency, chronic renal failure, chronic obstructive pulmonary disease, and ascending aortic atherosclerosis. Coronary interventions and their indications are expanding, and most of the surgical patients are severe multivessel lesions; therefore, the number of units and cases undergoing OPCAB will continue to rise. Second, small incisions for cardiac valve surgery are relative to conventional incisions and are inappropriately defined by specific length values. According to the relationship between small incisions and the sternum, they can be divided into three categories, including small incisions with partial splitting of the median sternum, parasternal incisions, and small lateral chest wall incisions [3-6]. Small-incision minimally invasive heart valve surgery is indicated for single-valve lesions with good cardiac function, small hearts, and no severe pulmonary hypertension, such as simple aortic valve replacement wood, mitral valve replacement and plication, tricuspid valvuloplasty, and also applied to ascending aortic replacement or Bentall surgery. Small right parietal sternal incision: an incision is made from the 2nd rib to the 4th rib 2-3 cm lateral to the right sternal border, after separating the pectoralis major muscle, the 2nd and 3rd rib cartilage is cut, the pericardium is incised, the ascending aorta and right auricle are cannulated, and extracorporeal circulation is established. This route was used early for aortic valve replacement and was gradually abolished because of the postoperative paradoxical chest wall motion and injury to the internal mammary artery. Partial splitting of the upper sternum: An incision is made from 2 fingers below the sternotomy to the fourth intercostal space, 8 to 10 cm long, partially splitting the upper sternum and partially transecting it toward the right 4th intercostal space. Partial splitting of the lower sternum: the incision was made from the 2nd intercostal space to the glabella, and the sternum was transected to the right at the 2nd intercostal space. Small intercostal incision: anterolateral incision of the right 4th intercostal space, 5-8 cm long. but this incision is poor for the exposure of the ascending aorta, and it is advisable to take a femoral artery tube, and the superior and inferior vena cava can be cannulated as usual or inserted into a right angle tube. Aortic block is performed with a Cosgrove blocking forceps with a serpentine bendable arm, or under induced ventricular fibrillation, or intracardiac operation is completed without aortic blocking cardiac arrest. Myocardial protection and venting are important for minimally invasive heart valve surgery. Intraoperative transesophageal ultrasound allows monitoring for complete venting. In recent years, minimally invasive cardiac surgery has been widely studied and performed worldwide, creating a boom. Most people used to believe that small incisions could significantly reduce trauma, but although the reduction in incision may reduce some damage, the additional traction required for small incisions and the prolonged operative time due to poor visualization may increase the degree of trauma. Another controversial issue is the safety of small incisions. Because of the high risk of cardiac surgery and the need for extracorporeal circulation support, the reduction of the surgical incision undoubtedly creates difficulties in visualization, thus increasing the risk of the procedure. The reduction in incision length has brought a number of benefits to small-incision cardiac surgery, but it has also created new problems. Increasing the visibility of small incisions through various means will make small-incision cardiac surgery more practical. The use of robots for cardiac surgery had high hopes for cardiac surgeons. However, robotic cardiac surgery operations are time-consuming and have not demonstrated significant advantages over traditional surgery