The most recent innovation in thyroid surgery is the use of the Transoral Endoscopic Thyroidectomy-Vestibular Approach (TOTEVA). The approach was first described in 2011 by Richmond et al. with the first reports on patients appearing in 2014 by Anuwong et al. The vestibular approach eliminates scarring of the anterior neck and has been demonstrated to be safe with complication rates comparable to open surgery. This new surgical approach has grown rapidly in popularity and is likely to evolve into a significant part of any thyroid surgeon's armamentarium. This chapter discuss a history of the procedure, its indications, surgical steps, and a discussion on its benefits and safety. The most recent innovation in thyroid surgery is the use of the Transoral Endoscopic Thyroidectomy-Vestibular Approach (TOTEVA). The approach was first described in 2011 by Richmond et al. with the first reports on patients appearing in 2014 by Anuwong et al. The vestibular approach eliminates scarring of the anterior neck and has been demonstrated to be safe with complication rates comparable to open surgery. This new surgical approach has grown rapidly in popularity and is likely to evolve into a significant part of any thyroid surgeon's armamentarium. This chapter discuss a history of the procedure, its indications, surgical steps, and a discussion on its benefits and safety.