If the surgical advances of the last decade were to be characterized in a single phrase, it would be the ineluctable movement toward minimal access surgery. Beginning in 1910 with Jacobaeus' work with pleural space problems and tuberculosis and progressing with the development of fiberoptic light sources and imaging successively through gynecologic surgery with tubal ligation, general surgery with cholecystectomy, and orthopedic surgery with arthroscopy, this movement has reached full flower as new technologies are brought to bear on cardiothoracic surgery. The technology associated with this movement is moving so quickly that one might question whether a full-blown text in this area would be yesterday's news by the time it actually became available. As will become evident in this review, however, I found much in Minimal Access Cardiothoracic Surgery, recently published by WB Saunders, which will be worthy of interest for some time to come. The editors of this text will be recognized by any thoracic surgeon as the vanguard of surgeons who have led the applications of these techniques to cardiothoracic surgery in the United States and Asia. For a concise and truly revealing review of the text, one need go no farther than the foreword by Thomas B. Ferguson, MD, a man whose career has encompassed both the beginning of the open cardiac era and the beginning of what might be called the closed-chest era in cardiac surgery. As his foreword in the fine introductory chapter by Mark Braimbridge points out, the strength of this text lies in its point–counter point appraisal of where this technology is going and how its impact on disease processes will be measured. The editors have followed almost every chapter with at least one critical commentary and have wisely chosen discussants who are not necessarily advocates of the approach being depicted. The commentaries are thought provoking and in some cases heated (see for example the commentary on minimal access approaches to thymectomy by Alfred Jaretski), but their uniform effect is to focus on the issues of patient welfare and the reasonable expectation that that end not be sacrificed for reasons of cost, cosmetic impact, or even pain.