Abstract: Objective: To compare the efficacy between the transoral endoscopic thyroidectomy vestibular approach (TOETVA) and the conventional open thyroidectomy (OT) for unilateral papillary thyroid cancer. Methods: Eighty patients who underwent radical surgery for unilateral thyroid cancer were randomly selected,with 40 cases for the transoral vestibular approach (endoscopy group) and the conventional open approach (open group).The preoperative baseline data (gender,age,BMI,tumor side,tumor length),the intraoperative indicators (bleeding volume,operative time,number of area Ⅵ lymph node dissection) and the postoperative indicators (drainage volume on the first postoperative day,postoperative 24 h VAS score,postoperative hospital stay,postoperative complications,satisfaction with the incision) of the two groups were compared. Results: There were no statistically significant differences between the two groups of patients in terms of gender,BMI,tumor side,tumor length,bleeding volume,number of area Ⅵ lymph node dissection,length of postoperative hospital stay,and postoperative complications (P>0.05).The average age and postoperative 24 h VAS score of patents in the endoscopy group were significantly lower than those in the open group,while the operative time,drainage volume on the first postoperative day and satisfaction with the incision of patients in the endoscopy group were significantly higher than those in the open group (P<0.01). Conclusions: Compared with the conventional OT,TOETVA has a higher efficacy and safety with good cosmetic results.