Purpose: To develop a new approach of endoscopic resection for benign parotid tumor through a cosmetic retroauricular incision with a water sac establishing the operative space. Materials and Methods: Fifty-eight patients with benign parotid superficial lobe tumor were randomly assigned to an endoscopic (29 patients) or a conventional (29 patients) surgery group. The maximum diameter of the tumors was 6cm. The subjective satisfaction scores with the incision scar, incision length, operative bleeding volume, postoperative complications, and recurrence rate were compared between the groups. Results: All operations were successfully performed. The endoscopic incision length (4.30.5cm), bleeding volume (26.6 +/- 10.4mL), and incidence of temporary facial paresis (6.9%) differed from the conventional surgery group (P<.05). The scars were almost invisible behind the ear. The mean patient satisfaction score was 8.9 +/- 0.7 in the endoscopic surgery group and 6.7 +/- 1.8 in the conventional surgery group (P<.05). Otherwise, Frey's syndrome and salivary fistula incidences were 3.4% (1/29) and 3.4% (1/29), respectively, in the endoscopic surgery group, which was not significantly different from the conventional surgery group (P>.05). No tumor recurrence was found during the 3-72 months of follow-up. Conclusions: Endoscopic resection through a cosmetic retroauricular incision with a water sac establishing operative space is a feasible method for treatment of benign parotid superficial lobe tumor. Its main advantages are that the small and concealed operative scars improved the cosmetic results, and it provided a novel method for establishing the operation working space that could reduce the operative trauma.