Minimally invasive right thoracotomy approaches to complex mitral valve surgery have emerged as safe and effective alternatives to traditional median sternotomy. Early experiences were associated with concerns over repair failures, neurological events and longer cardiopulmonary bypass times. However, several technique refinements over the last decade have led to a resurgence of minimally invasive thoracotomy/thoracoscopic mitral surgery with improved short-term outcomes and equivalent long-term durability to sternotomy. We describe one such approach that utilizes video assistance along with direct vision to facilitate reproducible mitral surgery.