This chapter elucidates the critical techniques and considerations essential for optimal access to the cervical oesophagus and surrounding structures. Emphasising patient positioning, meticulous incision, and dissection strategies, it underscores the significance of avoiding injury to vital structures, particularly the recurrent laryngeal nerve. Techniques such as nerve monitoring are highlighted for minimising nerve injury risks, especially in complex cases. Detailed descriptions of lateral and anterior approaches, along with insights into accessing the cervical oesophagus in previously operated necks, and offer valuable procedural guidance. Moreover, the chapter discusses challenging cases, providing case summaries and learning points to navigate difficulties encountered during surgery, ensuring safe and effective outcomes. Additionally, it touches on abdomen access techniques, offering a comprehensive overview of surgical access considerations for cervical and abdominal surgeries.