Background Currently, endoscopic thyroidectomy techniques continue to evolve in response to the growing demand for better cosmetic outcomes. To date, transoral endoscopic thyroidectomy via the vestibular approach (TOETVA) remains the only technique that leaves no visible external scar. However, this approach has certain limitations. The primary objective of this report is to present our initial experience with an alternative to TOETVA, namely the Transoral Endoscopic Thyroidectomy via Submental approach (TOETSA), in 38 patients at a single center. Method We performed the TOETSA procedure on 38 patients who met the inclusion criteria between January 2020 and Desember 2023. The procedure was successfully completed in 36 cases, while conversion to open thyroidectomy was required in 2 cases. Unlike conventional TOETSA, in which all instruments are introduced transorally, this approach utilizes two instruments inserted via the vestibular access and one instrument introduced through the submental crease. Results Among the 38 TOETSA procedures completed successfully, all specimens were extracted intact, with a mean maximum nodule size of 4.01 ± 0.80 cm (range: 2.50–6.40 cm). The mean operative time, which included procedures on large tumors and simultaneous training of novice surgeons, was 186.82 ± 19,46 (range: 147–226 Minutes). No life-threatening or permanent postoperative complications were observed. Cosmetic satisfaction after 6 months of follow-up was also favorable. However, a comprehensive assessment of oncologic safety could not yet be performed, as most patients were only monitored for 8.6 months in average. Conclusion TOETSA offers favorable therapeutic and cosmetic outcomes with low complication rates, even in larger specimens. Oncological safety should remain the main consideration in technique selection. TOETSA is also feasible as a training platform for novice surgeons. © 2025 Elsevier Ltd.