Clinical characteristics of Differentiated thyroid cancer (DTC) include the high rate of lymph node metastasis and the onset of young patients. With recent development of endoscopic thyroid surgery, neck scar could be avoided, which was increasingly popular. For patients with PTC combined with lateral cervical lymph node metastasis, total endoscopic functional modified neck dissection could achieve better cosmetic outcome with less postoperative psychological trauma. However, these complex surgical procedures require high level of cooperation of surgical team, under certain surgical indications and contradictions. The key of a successful endoscopic thyroid surgery also require skillful application of needle instruments. This article reviewed the difficulties and controversies of endoscopic radical resection for differentiated thyroid cancer.