The main purpose of the reported endoscopic thyroidectomy with the several incisions on the chest wall or other approaches was to meet the cosmetic demands of patients, but they had inherent technical disadvantages. To solve these problems, we developed a single-incision gasless trans-subclavian approach endoscopic thyroidectomy and evaluated its feasibility. We reviewed clinical data from 243 consecutive patients who underwent gasless trans-subclavian approach endoscopic thyroidectomy with a single incision at our centre from January 2021 to March 2022. Patients' basic information, the extent of surgery, the duration of surgery, the number of lymph node dissection, postoperative hospital stay, complications, and follow-up outcomes were collected and analysed. No cases converted to open surgery. The mean time for lobectomy + central neck dissection was 84.9 ± 29.9 min and 95.0 ± 24.3 min for lobectomy. The mean number of lymph node dissection in the central compartment was 5.6 ± 3.9, with a mean number of metastatic lymph nodes of 0.8 ± 1.6. Temporary recurrent laryngeal nerve (RLN) injury occurred in eigth patients, and minor lymphatic fistula occurred in one patient. During at least 6 months of follow-up, one patient was found to have a recurrence of lateral neck lymph nodes by ultrasound 6 months after surgery. The single-incision gasless trans-subclavian approach endoscopic thyroidectomy is a feasible and truly minimally invasive procedure for selected patients, providing a scarless cervical appearance. Given the simplicity and ease of learning, this surgical technique is well-suited for widespread clinical application.