Background and Aims Since transoral endoscopic thyroidectomy is performed via a natural cavity, there is no scar on the body surface, and no blind spots of the visual field in the central neck area. So, it well-accepted by doctors and patients. However, the traditional transoral endoscopic thyroidectomy using CO₂ inflation to maintain the surgical space has a narrow working cavity with easy smoke generation, which affects the vision. In addition, compared with other approaches, transoral endoscopic thyroidectomy is more prone to CO₂-related complications. Therefore, the use of gasless method for endoscopic surgery may be a better choice. For this reason, our center has designed a new method to perform gasless transoral endoscopic thyroidectomy by percutaneous suspension and three-hole endoscopic surgery technique. After continuous improvement, this technique has matured considerably. This paper discusses the feasibility and safety of this technique through a retrospective analysis, so as to provide a reference for clinical decision-making.Methods The clinical data of patients who underwent non-inflatable transoral endoscopic surgery for thyroid cancer in the Department of Head and Neck Oncology, the First Affiliated Hospital of University of Science and Technology of China (Anhui Cancer Hospital) from October 2020 to March 2022 were retrospectively analyzed. The operation was performed with a self-made suspension retractor and modified trocar.Results A total of 106 patients with papillary thyroid carcinoma were included. Of the patients, 11 cases were males and 95 cases were females with a mean age of (35.5±8.1) years; 91 cases underwent unilateral thyroidectomy, and 15 cases underwent total thyroidectomy; 106 cases received central lymph node dissection, and 7 cases received selective neck lymph node dissection. The operative time for endoscopic thyroidectomy alone was (163.9±49.1) min, and for endoscopic thyroidectomy combined with lateral neck lymph node dissection was (331.0±103.9) min. The number of resected lymph nodes in the central area was 8.6±6.1 and in the unilateral neck was 19.4±7.6 after operation. The length of postoperative hospital stay was (5.4±1.4) d. Transient hoarseness and lymphatic leakage occurred in one case each after the operation, and no postoperative complications such as bleeding, infection, and permanent mental nerve injury occurred.Conclusion Gasless transoral endoscopic thyroidectomy has no CO2-related complications. The use of self-made suspension hooks can maintain enough operation space. The application of an improved trocar reduces the interference of instruments, and the added endoscopic aspirator is convenient for surgical operation.