Minimally invasive cardiac surgery (MICS) via mini-right thoracotomy approach has been developed and standardized in the last 30 years, aiming to facilitate postoperative recovery and to minimize surgery-related complications. Mitral regurgitation is the major target of this MICS approach. In our institute, MICS mitral valve repair by direct vision under thoracoscopy guidance has been performed in 139 cases between 2011 and March 2018. Subsequently, robot-assisted surgery program was launched to perform mitral valve repair for 130 patients in the last 2 years. In-hospital and mid-term outcome post-mitral valve repair was not significantly different among sternotomy, MICS direct vision and MICS robot-assist approaches, though there were several pitfalls through the launch of the MICS program. Standardization of the MICS approach of mitral valve repair and other cardiac surgeries was herein summarized and associated pitfalls were explained from surgeons' view.