Introduction: Majority of petrous bone and lateral skull base pathologies are benign in nature. The complex anatomy usually warrants an extensive approach with associated morbidity.Case summary: Two cases of petrous bone cholesteatoma (1 congenital cholesteatoma with facial palsy and 1 acquired cholesteatoma) and a case of glomus tympanicum were treated with exclusive endoscopic transcanal approach. The cases of petrous cholesteatoma were addressed with trans-promontorial and infra-cochlear approaches. The mean operative time was approximately 140 min. No CSF otorrhoea was noticed in the post-operative period. The average period of hospital stay was 3.7 days. Conclusion: In the subset of cases with limited benign disease an endoscopic trans-canal approach is a better alternative to an external approach. It decreases operative time, blood loss, chance of meningitis, morbidity and hospital stay. The lack of depth perception is a major hurdle which can be come over by experience in endoscopic middle ear surgery. This approach can create direct access to cochlea/petrous apex/internal auditory canal (IAC)/Supra-geniculate ganglion region.