Objective: To compare the surgical effects of modified Miccoli’s approach versus total endoscopic approach in treatment of benign thyroid nodules. Methods: Forty-eight patients with benign thyroid nodules underwent thyroid adenoma resection, partial thyroidectomy, subtotal thyroidectomy, or unilateral thyroid lobectomy with modified Miccoli’s approach (modified Miccoli’s group, 24 cases) or total endoscopic approach (total endoscopic group, 24 cases). The operative time, intraoperative blood loss, postoperative pain scores, postoperative drainage volume, score for satisfaction with the incision, length of hospital stay, hospitalization costs and incidence of postoperative complications between the two groups were compared. Results: The parameters that included operative time, intraoperative blood loss, postoperative pain scores, postoperative drainage volume in modified Miccoli’s group were all significantly superior to those in total endoscopic group (all P<0.05), but the score for satisfaction with the incision in total endoscopic group was higher than that in modified Miccoli’s group (P<0.05). There was no statistical difference in terms of length of hospital stay, hospitalization costs or incidence of postoperative complications between the two groups (all P>0.05). Conclusion: The modified Miccoli’s approach has distinct advantage in treatment of benign thyroid nodules and can be regarded as a preference, while the total endoscopic approach is suitable for those with high cosmetic expectations.