One hundred one patients with lumbar spinal stenosis were randomized to receive Delta large-channel endoscopy (n=50) or unilateral biportal endoscopy (UBE) (n=51). The primary outcomes of interest were the Oswestry Disability Index (ODI) scores and operative time. Secondary outcomes included visual analogue scale (VAS) for pain, EQ-5D scores, Japanese Orthopaedic Association (JOA) scores, intraoperative blood loss, hospital stay duration, and costs. Outcomes were assessed at 14 days, 1, 2, and 3 months postoperatively. Overall, the results revealed significant early postoperative improvement in ODI scores at two weeks in the Delta endoscopy group compared to UBE and significantly shorter operation times. Delta endoscopy also reduced intraoperative blood loss and hospitalization costs. These findings suggest Delta large-channel endoscopy offers faster early postoperative recovery and operational advantages over UBE for lumbar spinal stenosis surgery.