Abstract: Objective To compare the cost and perioperative outcomes of totally robotic repair with assistance of da vinci surgica system and transcatheter interventional occlusion for adult with secundum atrial septal defect. Methods From January 2008 to December 2015, 243 secundum atrial septal defect patients hospitalized in our department were included with 100 cases receiving total endoscopic atrial septal defect repair with the assistance of da vinci surgical system (TEASD-R group) and 143 cases receiving transcatheter interventional occlusion (TIASD-O group). There were no significant differences in age, gender, BMI and preoperativ complications between two groups (P＞ 0.05). Medical records were analyzed and complication, blood transfusion and in-hospita condition (length of stay, length of stay after operation and cost) were assessed and compared between two groups. Results Th procedural success rate was 100% for both groups, and there were no in-hospital deaths. Complication analysis indicated that th number of patients with residual shunt (n=4), pericardial effusion (n=7), cerebral infarction (n=1), peripheral vascular embolism (n=2), new onset of arrhythmia (n=29) and wound healing failure (n=2) in TIASD-O group was significantly higher than those o TEASD-R group in 72h after operation. There was significant difference in postoperative arrhythmia between two groups (P=0.000) No patients in TEASD-R group had tricuspid regurgitation, while 27 cases in TIASD-O group had mild tricuspid regurgitation 8 cases had moderate tricuspid regurgitation and 2 cases had severe tricuspid regurgitation, which showed significant difference between two groups (P=0.000). Conclusion Totally robotic repair with assistance of da vinci surgical system for adult with secundum atrial septal defect is more feasible, safe and efficacious in perioperative period, however it has longer length of in-hosptia stay, operative and recovery time and higher expense.