ObjectiveTo compare the efficacy of transoral vestibular endoscopic thyroidectomy (TOET) and transaxillary endoscopic thyroidectomy (TAET). MethodsRelevant literature comparing the two surgical approaches was retrieved via computer from both domestic and international databases from inception to April 2025. The included studies were analyzed using RevMan 5.4 software, with observation indicators including operative time, intraoperative blood loss, number of central lymph nodes dissected, postoperative drainage volume, postoperative pain score, postoperative parathyroid hormone level, postoperative complications rate, total hospital stay, and incision satisfaction. ResultsA total of 13 studies involving 1 619 patients (784 in the TOET group and 835 in the TAET group) were included. Compared with the TAET group, the TOET group had longer operative time [MD (95%CI)=17.04 (3.40, 30.69), P=0.01], more number of central lymph nodes dissected [MD (95%CI)=1.89 (0.68, 3.10), P=0.002], higher postoperative complications rate [OR (95%CI)=1.46 (1.03, 2.05), P=0.02], shorter total hospital stay [MD (95%CI)=–0.14 (–0.23, –0.04), P=0.005], and better incision satisfaction [OR (95%CI)=4.30 (1.53, 12.05), P=0.006]. There were no statistically significant differences between the two groups in intraoperative blood loss [MD (95%CI)=–0.29 (–1.25, 0.68), P=0.56], postoperative drainage volume [MD (95%CI)=–9.63 (–35.38, 16.11), P=0.46], postoperative pain score [MD (95%CI)=0.05 (–0.77, 0.86), P=0.91], or postoperative parathyroid hormone level [MD (95%CI)=–2.71 (–5.60, 0.18), P=0.07]. ConclusionsTOET demonstrates advantages in the number of lymph nodes dissected, incision satisfaction, and total hospital stay. However, it is associated with a longer operative time and a higher complications rate. The choice of surgical approach should be based on a comprehensive consideration of the patients’ cosmetic needs, tumor characteristics, and the surgeon’s experience.