Objective: To compare the clinical effects between endoscopic thyroidectomy via bilateral areolar approach and conventional open thyroidectomy in treatment of T1 papillary thyroid cancer (PTC). Methods: The clinical data of 56 patients with T1 PTC undergoing endoscopic thyroidectomy via bilateral areolar approach (endoscopic group) and 56 patients with T1 PTC undergoing conventional open surgery (open surgery group) from January 2016 to December 2017 were retrospectively analyzed. Results: There were no significant differences in preoperative data and surgical procedures between the two groups (all P>0.05). The average operative time in endoscopic group was significantly longer than that in open surgery group (132.1 min vs. 96.7 min, P<0.05), but no significant differences were noted in intraoperative blood loss, the number of dissected lymph nodes, rate of positive lymph nodes and incidence of postoperative complications between the two groups (all P>0.05). In endoscopic group, the operative time and incidence of postoperative temporary hypocalcemia were increased in patients with the diameter of lesion less than 1 cm compared with those with the diameter of lesion from 1 to 2 cm (both P<0.05), but no significant differences were seen in intraoperative blood loss, number of dissected lymph nodes and rate of positive lymph nodes and incidence of postoperative complications between them (all P>0.05). No signs of recurrence or metastasis were noted in both groups during follow-up. Conclusion: Endoscopic thyroidectomy via bilateral areolar approach is safe and feasible for T1 PTC, and it also has similar clinical efficacy to that of open thyroidectomy.