Objective: To compare the clinical efficacy of complete areolar approach and chest/breast approach for endoscopic thyroidectomy of papillary thyroid microcarcinoma. Methods: The clinical data of 50 patients with papillary thyroid carcinoma undergoing endoscopic resection of the thyroid lobe and isthmus and central neck dissection from January 2014 to June 2015 were retrospectively analyzed. Endoscopic thyroid surgery was performed via complete areolar approach in 21 cases (complete areolar group) and via chest/breast approach in 29 cases (chest/breast group). The main clinical variables between the two groups of patients were compared. Results: There was no statistical difference in age and maximum diameter of tumor between the two groups of patients (both P>0.05). Endoscopic surgery was successfully completed in all patients. In complete areolar group versus chest/breast group, all the variables that included the average number of resected lymph nodes (5.90 vs. 6.07), operative time (99.95 min vs. 99.17 min), intraoperative blood loss (23.81 mL vs. 28.21 mL), length of hospital stay (5.19 d vs. 6.07 d), and postoperative pain score as well as incidence of postoperative complications had no statistical difference (all P>0.05), but the degree of patients’ satisfaction with surgical incision in complete areolar group was significantly higher than that in chest/breast group (8.81 vs. 6.59, P<0.0001). Conclusion: For papillary thyroid microcarcinoma, endoscopic thyroidectomy via complete areolar approach has equivalent clinical efficacy to that via chest/breast approach, but the former offers better cosmetic results, so it is a safe and favorable approach.