Background and Aims Various neck scarless surgeries have gradually matured in recent years. Transoral endoscopic thyroidectomy via vestibular approach (TOETVA) has gained popularity among doctors and patients due to its shorter path, convenient and thorough lymph node dissection, and absence of visible scars. However, in the initial TOETVA cases the authors' team performed, some patients experienced varying degrees of chin numbness, reduced lower lip mobility, swelling and deformation, and hardening of chin scars after operation. Therefore, the team adopted a 5 mm endoscope for transoral thyroid surgery, supplemented by an axillary approach for assistance and specimen retrieval. This combined method is termed the axillary channel-assisted transoral endoscopic thyroidectomy vestibular approach (AcaTOETVA). For patients with a prominent chin bone, where establishing the oral observation channel is difficult, a 5 mm submental incision is made to create the observation channel to perform submental and axillary channel-assisted transoral endoscopic thyroidectomy vestibular approach (SaAcaTOETVA). This paper summarizes the limited cases of this surgical method to explore its feasibility, advantages, and disadvantages preliminarily.Methods The clinical data of 6 patients who underwent SaAcaTOETVA in the Breast and Thyroid Surgery Department of Wuhan First Hospital from September to November 2020 were retrospectively analyzed.Results All 6 patients completed the surgery. Among them, 3 patients underwent left thyroid lobectomy with left central lymph node dissection, 1 patient underwent right thyroid lobectomy with right central lymph node dissection, 1 patient underwent near-total right thyroid lobectomy, and 1 patient underwent near-total bilateral thyroid lobectomy. The surgery duration ranged from 100 to 155 min, intraoperative blood loss was 10 to 20 mL, and the postoperative hospital stay was 3 d. No patients experienced recurrent laryngeal nerve injury, subcutaneous hematoma, chin nerve injury, chin and lip numbness, chin swelling, hypocalcemia, swallowing difficulties, CO₂ embolism, or delayed wound healing. One patient had a small bruise on the chin due to a puncture of the operation hole, which resolved within a week. On one-month postoperative follow-up, the submental incision healed well, and when standing normally, the incisions were hidden under the chin and in the armpit, making them relatively inconspicuous. Patients were satisfied with the submental and axillary incisions, and postoperative examinations found no tumor implantation, recurrence, or metastasis.Conclusion SaAcaTOETVA is safe and feasible and is an important supplement to AcaTOETVA for specific cases. It features relatively hidden and aesthetically pleasing incisions. However, issues with the clarity of the 5 mm endoscope and the initially small working space may affect the widespread adoption of this surgical method.