Objective: To evaluate the safety of a novel modified retracting arm for endoscopic thyroidectomy by gasless unilateral axillary approach (ETGUA) and its effectiveness in minimizing complications. Methods: A novel retracting arm, which comprises a suspension part, a retracting arm, and a suction tube, was designed for ETGUA. The thyroid pull hook used in this study is an approved medical device: Su Xu, 20210063 (https://scjgj.xz.gov.cn/).The cohort of this randomized controlled study included 84 patients with unilateral thyroid cancer who underwent ETGUA at  Xuzhou Central Hospital from February 2021 to March 2023. The patients (n=42/group) were randomly assigned to a control group (conventional endoscopic retracting arm) or an experimental group (modified endoscopic thyroid retracting arm). Clinical indicators, complication rates, neck pain scores, and cosmetic scores were compared between the two groups. Results: There were no significant differences in hospitalization time, surgical duration, intraoperative blood loss, postoperative drainage volume, hypoparathyroidism, or postoperative hematoma between the groups. However, there were significant differences in the incidences of transient recurrent laryngeal nerve injury (x2=6.65, p=0.02) and transient superior laryngeal nerve injury (x2=4.49, p=0.03), as well as visual analog scale scores on postoperative day (POD) 1 and 7 (tPOD1=12.66; tPOD7=10.54; both, p<0.001), and  cosmetic scores (t=-15.27, p< 0.05). Conclusion: The modified retracting arm was safe and effective for ETGUA.