The main points of surgical procedures were as follows: thyroidectomy were performed via an Chest-breast approach. Under the direct view, ultrasonic scalpel was used to establish subcutaneous surgical space below the jugular broad muscle, with outer edge of the sternoclavus muscle on both sides and upper edge of thyroid cartilage. Cervical linea alba was dissected by using ultrasonic scalpel. The front, lower and outer sides of the thyroid gland were separated through loose space between dorsal membrane of thyroid. The anterior cervical muscle groups were pulled by using endoscopic hook to expand surgical space. To fully expose and to separate anterior trachea space, then to cut off isthmus. Thyroid lobes were exposed by delicate dissection along the thyroid membrane to avoid damage to the parathyroid gland. Four steps of neural detection were used to search and monitor the recurrent laryngeal nerve signal. Make sure a 3 mm distance between surgical plane and nerve when using ultrasonic scalpel. After the lobe dissociate completely, the superior thyroid artery were cliped and cutted off, to prevent late bleeding. The resected specimens were taken out for pathological examination by using specimen bag. The anterior cervical muscle groups was sutured with absorbable lines . Finally, drainage tube was placed.