Multiple peripheral pulmonary artery stenoses are a challenging set of lesions that have a long history of being managed primarily in the catheter lab. The very fact that these are usually widespread, bilateral, and often deep within the lung tissue seemed to make them ideal for angioplasty technologies, including cutting balloons and even stenting-as they were deemed to be inaccessible to standard surgical approaches. This series of primary surgical repair from Al-Khaldi and colleagues 1 in this edition of the Journal has added to a potentially disruptive change in what can be offered surgically for this condition. Together with several reports from the Stanford group, this represents a bold and impressive display of what can be achieved with highly skilled and single-minded surgical perseverance. The demonstration that the entire pulmonary vascular tree (out to segmental branches) can be accessed safely and effectively without the need for hypothermia and circulatory arrest is a testament to improved surgical techniques and expertise, including the importance of meticulous dissection and the use of multiple stay sutures and Yasargil clips to control back bleeding. The outcomes from both this series and from Stanford have been outstanding, with dramatic reduction in right ventricular pressures and freedom from reintervention, which ask us to re-think the way we should be approaching these patients.In the modern era, it is tempting to feel that traditional surgical techniques are plateauing in terms of the range of lesions that can be treated-and that advances are more likely to come through minimally invasive, hybrid, or interventional techniques. It is rare to see that the boundaries of traditional surgery can still be pushed into areas previously not felt possible, and we should applaud these pioneers of the surgical craft.