Because of the restricted freedom of movement inherent in endoscopic standard instruments wholly endoscopic heart surgery has not been possible up to now. The development of such techniques was especially hindered by the rib cage. Now the precision which is imperative for bypass surgery or valve reconstruction is made possible by telemanipulator systems. Preconditions for this method are cardiopulmonary bypass-techniques which allow a cardioplegic cardiac arrest with closed chest and extensive hemodynamic monitoring which enables the anesthesiologist to make exact diagnoses without having a direct view on the heart. After an extensive experimental phase a telemanipulation system is successfully in use since May 1998 in the Cardiac Center in Leipzig.