Beside the tremendous developments in cardiac surgical procedures, the use of cardiopulmonary bypass (CPB) remains the gold standard to perform cardiac surgery but is associated with detrimental effects (e.g. hemodilution and blood-air interface). Minimally invasive extracorporeal circulation (MiECC) has been designed in attempt to integrate all the advances in cardiopulmonary bypass technology in one closed circuit to minimize these systemic deleterious effects and therefore ideally can be used for cardiopulmonary support in addition to bypass for the adaption of minimal invasive surgical approaches. Due to the complexity and extreme invasiveness of CPB, strict attention needs to be paid to all safety aspects when using these minimized circuits. We want to share our experience in multi-vessel coronary bypass surgery by endoscopic set up and other MICS procedures in combination with the use of a minimal invasive perfusion circuit focusing on the overall safety aspects.