Aims To investigate a modified method of epicardial left atrial appendage (LAA) occlusion under the guidance of thoracoscopy and transesophageal echocardiography (TEE) during radiofrequency ablation of atrial fibrillation. Methods and Results 19 patients with atrial fibrillation underwent left atrial appendage occlusion and atrial fibrillation radiofrequency ablation in two centers under the guidance of thoracoscopy and TEE. All of the surgeries were completed in a general surgery setting, avoiding fluoroscopy, and in each case the entire procedure was guided by TEE. Radiofrequency ablation of atrial fibrillation was performed by Wolf mini-maze. All operations went smoothly with no serious complications. Postoperative TEE indicated that each device was in a good position and there was no residual shunt around any of the devices. Conclusions It is safe and reliable to apply the left atrial appendage closure device to perform epicardial left atrial appendage occlusion guided only by TEE, which is radiation-free. And it can be performed simultaneously during the thoracoscopic radiofrequency ablation of atrial fibrillation.