Objective: To investigate the feasibility and clinical efficacy of endoscopic axillary lymph node dissection in breast-conserving surgery for early-stage breast cancer. Methods: The clinical data of 98 patients with early-stage breast cancer who underwent breast-conserving therapy were retrospectively analyzed. Of the patients, 41 cases underwent endoscopic axillary lymph node dissection (endscopic group) and 57 cases underwent conventional axillary lymph node dissection (conventional group). The operative time, blood loss, number of the lymph node dissected, complications and prognosis of the patients between the two groups were compared. Results: Operations were performed in all patients of the two groups. In the observation group and conventional group, the average operative time was 99.5 and 61.5 min (P<0.05), average number of axillary lymph nodes dissected was 17.6 and 18.6 (P>0.05), average number of positive lymph nodes was 2.1 and 2.4 (P>0.05), average intraoperative blood loss was 35.4 and 61.5 mL (P<0.05), respectively. Follow-up was conducted for 1–4 years. No recurrence or metastasis and no postoperative complications were noted in the endscopic group. There was one case each of arm edema on the affected side, poor wound healing of breast incision, local recurrence, lung metastases and tibia metastases in the conventional group. No death occurred in either of the groups. Conclusion: Endoscopic axillary lymph node dissection can achieve an axillary node clearance as complete as that obtained by conventional open dissections. In addition, the endoscopic procedure has the advantages of fewer complications and better cosmetic results.