Background Myxoma is the most frequent cardiac benign tumor which requires surgical removal even though in right atrium.Minimally invasive surgery has become the standard approach for removal of myxoma in our center.Herein,we report our initial experience of cardiac myxoma removal through mini-port totally thoracoscopic particular with focus on its feasibility,efficacy and short-term outcomes,as compared with median steotomy.Methods From April 2015 to March 2019,31 consecutive cases were ultimately identified and divided into two groups (Mini-port thoracoscopic group,n=14;versus conventional median steotomic group,n=17).An echocardiography was routinely performed prior to discharge,at 1st month,6th month,12th month and every year postoperatively.Retrospective analyses of perioperative data,postoperative outcomes and complications,and follow up data were performed.Results All the 31 patients successfully underwent fight atrial myxoma removal surgery with no perioperative death,re-exploration for bleeding,residual mass or central nervous event in both groups.Intraoperative data from two group showed absence of significant difference except the intraoperative blood loss (150±50.01 mL in mini-port thoracoscopic group vs.255.88±93.35 mL in conventional median steomtomic group,P=0.01).There was no significant difference in perioperative blood transfusion and postoperative outcomes between the two groups.But the mini-port thoracoscopic group had a much less 24-hour postoperative drainage (136.71±148.20 mL vs.341.17±211.29 mL,P=0.03).No significance difference could be identified between two groups about the incidence of postoperative morbidities and follow-up adverse events.Conclusion Totally mini-port video-assisted thoracoscopic approach for fight atrial myxoma resection on peripheral cardiopulmonary bypass is feasible,effective with favorable safety in experienced cardiac center.