Endoscopic surgery offers superior cosmetic results compared to open procedures and is strongly preferred by many patients, especially women. We performed total endoscopic thyroidectomy via the anterior chest approach using a neck skin-lifting technique in which the skin is lifted by a large number of hooks to create the working space. This method is quite flexible and can be modified based on the size of the space needed. The fine hooks leave no scar on the anterior neck, the skin incisions are small, and the scars are completely covered by patients' undergarments. Endoscopic thyroidectomy is suitable for benign thyroid nodules, but some malignant foci diagnosed by frozen section usually can be managed without conversion to an open procedure. Women under 45 years of age with nodules <2 cm who have no evidence of lymphatic spread or local invasion are ideal candidates for this procedure.