Objective To observe the surgical effect of endoscopic thyroidectomy via different surgical approaches on stage cN0 papillary thyroid carcinoma (PTC). Methods The clinical data of patients with stage cN0 PTC who underwent endoscopic surgery in our hospital from August 2019 to November 2022 were retrospectively analyzed. According to different endoscopic surgical approaches, they were divided into thoracic breast group and transoral group. The propensity score matching method was used to selected 59 patients in each group. The perioperative indicators compared between the two groups. Results The postoperative drainage volume and hospital stay in transoral group were less or shorter than those in thoracic breast group (P＜0.05), and the surgical time and the number of dissected central lymph nodes were longer or more than those in thoracic breast group (P＜0.05). The VAS scores in transoral group after surgery were lower than those in thoracic breast group (P＜0.05). At 3 days after surgery, the swallowing function in transoral group was higher than that in thoracic breast group (P＜0.05). The scores of Patient and Observer Scar Assessment Scale in transoral group at 3 months after surgery were lower than those in thoracic breast group(P＜0.05). After 1 year of follow-up, there was no difference in the total incidence rate of postoperative local recurrence and progression-free survival between the two groups(P＞0.05). Conclusion The short-term and long-term curative effects of endoscopic surgery via transthoracic breast approach and endoscopic surgery via transoral vestibular approach in the treatment of stage cN0 papillary thyroid carcinoma are comparable, but endoscopic surgery via transoral vestibular approach has faster postoperative recovery and better aesthetics