Objective: To investigate the experience and efficacy of endoscopic radical operation via bilateral areolar approach in treatment of papillary thyroid microcarcinoma. Methods: The clinical data of 23 patients undergoing endoscopic radical operation for papillary thyroid microcarcinoma via bilateral areolar approach between January 2015 and January 2017 were analyzed retrospectively. All patients had a solitary thyroid nodule, with tumor size ≤1.0 cm. None of the patients had cervical lymph node metastasis. Of the patients, 18 cases were female and 5 cases were male, with an average age of 37.13 years. Results: Radical thyriodectomy was successfully performed in all the patients, without any open conversion. No reoperation due to complications was required. The average operative time was 183.83 (155–221) min, time for postoperative drainage tube was 2.17 (2–3) d, and length of postoperative hospital stay was 2.39 (2–5) d, respectively. After surgery, mild choking when drinking fluids occurred in one case, which recovered within one week; varying degrees of subcutaneous emphysema occurred in 6 cases and, in all the cases, it was spontaneously absorbed within one week. No tumor recurrence, or lymph node and distal metastasis were found on regular follow-up to date. All patients showed minimal scar and good cosmetic results in postoperative follow-up observation. Conclusion: Endoscopic radical operation for papillary thyroid microcarcinoma via bilateral areolar approach is an effective, safe and feasible procedure, with favorable cosmetic results.