Background Endoscopic thyroidectomies have been performed using various approaches, and indications have expanded with the development of new surgical techniques and instruments.Endoscopic thyroid surgery using bilateral axillo-breast approaches have excellent cosmetic results and a symmetrical, optimal operative view.However, because of the two-dimensional view and the nonflexible instruments, these approaches are not easy to use in performing a central lymph node dissection (CND).Robotic surgery has drawn attention as a potentially safe and effective method for treating thyroid cancer.The aim of the present study was to determine whether robotic surgery is superior to endoscopic and open surgery through comparing technical aspects and surgical outcomes.Methods From October 2008 to December 2009, 302 patients had total thyroidectomies and CND with cancer less than 1 cm.Patients were divided into three groups according to operation methods (open group;n =138), (endo group;n =95),(robot group;n =69).Results Young patients preferred the robotic and endoscopic surgery.The number of retrieved lymph nodes in the open group (4.8 ± 2.8) was not different from the robot group (4.7 ± 2.7) and the endo group (4.6 ± 3.7).The operative time of the robot group was longer than the open and the endo group.The total drain amount in the robot group was more than the open and endo groups;however, there was no difference in the length of hospitalization and complication rates.There were no differences between the open (0.8 ± 2.0) and robot groups (0.8 ± 1.4), but the endo group (2.4 ±6.3) showed higher postoperative serum thyroglobulin off thyroid hormone (Off-Tg) when compared to the open and robot groups.Conclusions Robotic surgery was equal to open surgery except with respect to operative time and was superior to endoscopic surgery in Off-Tg levels presenting completeness of the operation in thyroid cancer surgery.Because it has excellent cosmetic results and various technical advantages, it should be considered in young, lowrisk patients with thyroid carcinoma less than 1 cm.