Minimally invasive cardiac surgery( MICS) has emerged in 1990s. Nowadays, MICS via mini thoracotomy became popular for valvular heart disease. Robot-assisted cardiac surgery was introduced with extension to MICS. Robot-assisted cardiac surgery for valvular heart disease has been covered by health insurance since 2018. So far, the number of authorized facilities for robot-assisted cardiac surgery is only 25. Currently available da Vinci surgical system is a burden to not only the surgical team but also the facility. There are a lot of problems to overcome for applying robot-assisted cardiac surgery as a standardized procedure. An educational institution like a university hospital needs to expand systematic human resource development and technological innovation for continuing and developing the robot-assisted cardiac surgery. The most important thing for the surgeon is to keep in mind for true minimally invasive surgery for the patients not for minimally incisional surgery for the cosmetic reason.
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