Transaxillary valve surgery: innovation through simplicity in minimally invasive cardiac surgery

Minimally invasive cardiac surgery (MICS) is widely recognized as an essential component of contemporary cardiac surgical practice, offering reduced surgical trauma, faster recovery, and improved patient satisfaction while maintaining excellent clinical outcomes. Nevertheless, despite decades of technological progress and growing clinical evidence, its adoption remains limited. One of the principal barriers to wider dissemination is the procedural complexity associated with many minimally invasive platforms. Reduced operative exposure, indirect visualization, and dependence on dedicated technology frequently result in demanding workflows, prolonged learning curves, and limited reproducibility. The right transaxillary mini-thoracotomy direct vision approach was developed according to a different philosophy. Rather than relying on additional technology to compensate for the constraints of minimally invasive access, it simplifies the operative platform by preserving the natural interaction between the surgeon and the operative field. By combining favorable surgical geometry, direct visualization, and a standardized operative platform, the transaxillary approach facilitates procedural efficiency, reproducibility, and potential applicability across a broad spectrum of minimally invasive valve surgery while relying primarily on conventional surgical instrumentation. More broadly, the transaxillary concept suggests that the future dissemination of MICS may depend not only on technological innovation, but also on the ability to simplify procedural execution, facilitate reproducibility, and lower the barriers to adoption.