The minimally invasive repair of pectus excavatum (PE), introduced by Nuss in 1998, represents the worldwide “gold standard” procedure for surgical repair. Modifications over years included routine use of unilateral or bilateral thoracoscopy as well as sternal elevation before starting the substernal dissection. In patients with a severe PE deformity, such as Grand Canyon type, use of a second bar or, in selected patients, even a third or fourth bar has to be considered. However, not only the number of bars but also positioning may vary.