Background: To explore clinical advantages and benefits of three-dimensional (3D) endoscopic thyroidectomy through areola approach in patients with papillary thyroid microcarcinoma (PTMC) and compare it to two - dimensional (2D) endoscopic thyroidectomy. Methods: 103 female patients diagnosed with PTMC in our department from January 2015 to December 2016 were reported. They underwent thyroid lobectomy and isthmus resection with dissection of central group lymph nodes endoscopically. 60 cases chose 3D endoscopy, and 43 cases chose 2D endoscopy. We observed the differences of the operation time, intraoperative error rates, intraoperative suction drain, number of lymph nodes dissection, postoperative serum calcium, parathyroid hormone, postoperative drain time, postoperative drain, postoperative hospital stay and hospital costs between the two groups. Results: Total operation time and operation time of every part during the whole thyroidectomy process in 3D group were evidently lower than those in 2D group (P < 0.05). Intraoperative error rates reduced obviously by employing 3D endoscopy (P < 0.05); there were no significant differences in other parameters between the two groups (P > 0.05). Conclusions: Using areola approach through 3D endoscopy for PTMC patients is convenient and safe. It provides significant improvement in operation time and intraoperative error rates for endoscopic surgeons during endoscopic thyroidectomy. Key words: two / three - dimensional, endoscopic thyroidectomy, papillary thyroid microcarcinoma