OBJECTIVES: To compare surgical outcomes between transareola single-site endoscopic thyroidectomy (TASSET) and minimally invasive video-assisted thyroidectomy (MIVAT). METHODS: Patients with thyroid nodules were randomized to TASSET (n = 24) or MIVAT (n = 24). Surgical outcomes and patient-rated cosmetic results, based on numerical (0 [worst], 10 [best]) and verbal (1 [poor], 4 [excellent]) response scales, were compared. RESULTS: There were no significant differences between groups for age, sex, indication for operation, estimated blood loss, postoperative pain and length of postoperative stay. TASSET was associated with a significantly longer mean +/- SD operative time than MIVAT (156.84 +/- 41.42 vs. 66.38 +/- 17.58 min), and significantly improved cosmetic results according to the numerical (9.63 +/- 0.60 vs 7.90 +/- 1.38) and verbal response (3.8 +/- 0.5 vs 3.1 +/- 0.7) scales. Postoperative complaints were comparable between the two approaches, although MIVAT involved a shorter operation time. CONCLUSIONS: Patients treated with TASSET had superior cosmetic results compared with those treated with MIVAT.