Background: The aim of this study was to evaluate and compare the early surgical outcomes of endoscopic and conventional open thyroidectomies in patients with papillary thyroid microcarcinoma (PTMC).Methods: Between September 2005 and December 2007, 499 patients with PTMC were enrolled. 275 patients underwent gasless endoscopic thyroidectomy via the axillary route (endo group), and 224 patients underwent conventional open thyroidectomy (open group). We analyzed the patient's clinico‐pathologic characteristics and surgical completeness between the two groups.Results: The endo group was younger than the open group. The open group underwent more extensive surgery than the endo group. The operative time was longer in the endo group than the open group (138.5 ± 49.0 min vs. 105.5 ± 41.6 min; P < 0.0001), and a lesser number of lymph nodes were retrieved in the endo group compared to the open group (5.05 ± 2.94 vs. 5.96 ± 4.50, P = 0.007). We experienced complications in the endo group, such as transient hypocalcemia, transient RLN palsies, tracheal injuries, and esophageal injuries. There was no abnormal uptake on RAI scans in the two groups. From among patients who had undergone total thyroidectomy, all patients in the endo group had 1 ng/ml of serum Tg post‐operatively. Tumor recurrence was detected in the open group only (n = 6). Also we checked the post‐operative Tg in patients who had undergone lobectomy in the two groups, and found that there were no statistical differences in the two groups.Conclusions: According to our experience, gasless endoscopic thyroidectomy using a trans‐axillary approach is a safe and feasible alternative to conventional open thyroidectomy in selected patients with PTMC. J. Surg. Oncol. 2009;100:477–480.