OBJECTIVE: This study aimed to summarize and explore how to establish a good surgical space via a gasless transoral endoscopic thyroidectomy vestibular approach (TOETVA) to facilitate smooth surgical progress. METHODS: This study was conducted between January 2022 and December 2023. The study involved 281 patients with papillary thyroid carcinoma who underwent gasless TOETVA at The First Affiliated Hospital of the University of Science and Technology of China. The suspension method was used to establish the surgical space during the operation. The key steps and difficulties of surgical space construction were summarized, and the clinicopathological characteristics and surgical complications of the patients were analyzed. RESULTS: The mean surgical duration was 167.86 ± 25.38 min, and the time needed to create the surgical space (from incision of the lip mucosa to incision of the anterior border of the neck) was 17.82 ± 9.44 min. During the construction of the surgical space, there was 1 case of thermal skin burn and 2 cases of bleeding from the anterior jugular vein, with no permanent injury to the mental nerve. CONCLUSION: In the gasless TOETVA, the suspension method of surgical space construction was employed to rapidly establish a stable three-dimensional operating space that was less prone to collapse, thus facilitating the smooth implementation of subsequent surgical procedures.