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To provide a good surgical environment, several considerations are required in anesthetic management. One-lung ventilation, effective use of transesophageal echocardiography, and regional oxygen saturation monitoring are important in addition to the standard practices necessary for cardiac anesthesia. Because direct observation of the heart is limited, transesophageal echocardiography is necessary to assess cardiac function or condition in MICS. Good communication between staff is very important to ensure a good outcome after MICS.