Objective To compare the clinical effect of single-hole thoracoscope under xiphoid and three-hole thoracoscope. Methods: With 110 patients undergoing mediastinal tumor resection from May 2020 to May 2023, divided into control group and observation group, three-hole thoracoscope and single-hole thoracoscope were used respectively, 55 patients in each group to compare the clinical treatment effect between groups. Results: The blood loss, postoperative drainage time, hospital stay, and analgesia frequency were lower than the control group (P <0.05); The VAS scores of both groups increased 24h after surgery, but the observation group was lower than the control group, and the observation group was lower than the control group, and the statistical significance between the groups was established (P <0.05); the scores of the observation group was higher than that of the control group (P <0.05).Conclusion: The application value of single-hole thoracoscopy under xiphoid is higher in anterior mediastinal tumor resection, which can improve the general situation of patients'' surgery, reduce the pain degree, and improve the postoperative quality of life of patients after surgery. It is suggested that clinical use is promoted.