Since the era of Theodor Kocher, thyroidectomy has conventionally been performed by an open approach and has been the standard of care over the years for both benign and malignant diseases of thyroid. The main caveat, however, is the need for 6–8 cm long ‘necklace’ incision on the anterior neck, which deters patients from undergoing surgery, especially young women. Since Gagner’s first descriptions of endoscopic parathyroidectomy in 1996, several endoscopic procedures have evolved using miniature cervical incisions, extra cervical incisions or scarless transoral approach. They may further be performed with or without gas insufflation. This chapter describes in brief the various approaches of minimally access thyroidectomy and highlights the pertinent literature.