Minimally invasive surgery (MIS) has changed pediatric urology and general surgery, offering less morbidity and new surgical options for many procedures. This promise goes unrealized when technical methods lag. Application of MIS in children is uneven after more than 2 decades of application. Principles of versatile and proficient technique may remain unstated and implicit in surgical training, often leaving surgical training an exercise in inference and imitation. This article describes some essential practical principles of precision MIS applied to patients of any size.