PURPOSE: Endoscopic surgery to treat thyroid neoplasm was developed to solve the aesthetic problems that resulted from conventional open surgery. Although endoscopic thyroidectomy was initially performed in patients with benign thyroid neoplasm, its use has recently been extended to patients with Graves's disease and early cases of thyroid cancer.The purpose of this study was to determine whether this surgical approach is feasible and safe for the treatment of thyroid cancer. METHODS: Between December 1999 and April 2006, 132 thyroid cancer patients at our institution were treated by either conventional thyroidectomy or endoscopic thyroidectomy. Endoscopic thyroidectomy was conducted using a gasless anterior neck skin lifting method. The inclusion criteria for endoscopic thyroidectomy in thyroid cancer patients included a tumor size of less than 2cm, absence of extrathyroidal extension, absence of cervical lymph node metastasis, and well differentiated cancers. RESULTS: We performed endoscopic thyroidectomy in 29 thyroid cancer patients. There were no significant differences in operative time, the amount of drainage and the number of retrieved lymph nodes between conventional thyroidectomy and endoscopic thyroidectomy. In addition, although endoscopic thyroidectomy was associated with more complications, it was also associated with a shorter hospital stay. CONCLUSION: The completeness of surgical resection conducted via an endoscopic thyroidectomy may be comparable to that of conventional surgery, however, a larger series and longer follow-up evaluation are necessary for definitive conclusions to be drawn about its oncologic validity.