['To compare the effect of totally thoracoscopic with conventional, open repair of atrial septal defect.', 'Forty atrial septal defect cases were divided into two groups by surgical approach: totally thoracoscopic approach (group A, n\u2009=\u200920) and conventional open approach (group B, n\u2009=\u200920). In group A, surgical procedures were performed through three portal incisions in the right lateral chest wall under thoracoscopic vision without the aid of a computerized robotic surgical system. Notably, all operations were completed by one surgeon who had just begun using this technique. In group B, the atrial septal defects were repaired in conventional open fashion. Clinical outcomes and serum levels of tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), interleukin-10 (IL-10), intercellular adhesion molecule 1 (ICAM-1), and creatine kinase isoenzyme-myocardial band (CK-MB) for the two groups were evaluated and compared.', 'All operations were performed successfully without serious complications. Durations of cardiopulmonary bypass (CPB), CPB setup, aortic cross-clamping, and operative procedure were significantly longer in group A than in group B (P\u2009<\u20090.05). The recovery times for body temperature and laboratory values of leukocytes were significantly shorter for group A than for group B (P\u2009<\u20090.05). There were no differences in durations of postoperative assisted ventilation or intensive care unit and hospital stays, volumes of blood transfused intraoperatively or thoracic drainage, or medical costs between the two groups. Serum levels of inflammatory factors (TNF-α, IL-6, IL-10, and ICAM-1) and CK-MB increased significantly in both groups after surgery. However, 6\xa0h and 12\xa0h after surgery, levels of these inflammatory factors and CK-MB were significantly lower in group A than in group B (P\u2009<\u20090.05).'] Does totally thoracoscopic repair of atrial septal defect reduce systemic inflammatory reaction and myocardial damage in initial patients?