Introduction: Transoral endoscopic thyroidectomy by vestibular approach (TOETVA) is a relatively new technique for the surgical treatment of thyroid diseases. We present the initial experience of a reference hospital of Mexico with TOETVA. Materials and Methods: This is a comparative retrospective study of cases (TOETVA) and controls (open thyroidectomy) treated by the endocrine surgeons between July 2017 and April 2019. Cases were patients of any gender, older than 18 years of age, with malignant thyroid nodules <2 cm or undetermined <5 cm without extrathyroidal extension and no lymph node or distant metastasis. Demographic, operative, and postoperative data were obtained and analyzed. Results: Twenty patients were surgically treated by TOETVA during the study period. Controls were paired based on type of surgery and dominant thyroid nodule. Ninety percent of the patients had a definitive diagnosis of malignancy. No statistically significant differences were found in age, BMI, length of stay, thyroid lobes size, and complication rates. Operative time was longer in TOETVA (216.7 ± 62.5 vs. 153.9 ± 49.25 minutes; t test P < .0001) and intraoperative blood loss was lesser for the TOETVA group (38.25 ± 38.9 vs. 101.8 ± 126.6 mL; t test P < .04). Conclusions: TOETVA is a feasible and relatively safe surgical technique for patients with benign and malignant thyroid diseases. Complication rates seem to be comparable with conventional open technique with lesser intraoperative bleeding; nevertheless, it requires longer operative times.