Fig. 1

The operative layout for the totally thoracoscopic mitral valve procedure. Drainage of the superior vena cava and right superior pulmonary vein, and cardioplegia perfusion cannula was passed through port 1 directly. Port 2 was located in the fourth intercostal space on a midclavicular line for the entry of instruments, such as scissors and prosthesis, or tissue removal. Port 3 was located in the fifth intercostal space on the right anterior axillary line (arrows). The left atrium was raised by a blade retractor and introduced through a 2-mm shaft penetrating parasternally in the fourth intercostal space and was held on the operating table (asterisk)