In clinical practice, we have made a series of technical improvements to total thyroidectomy based on the principles of tumor-free and minimally invasive, in an attempt to reduce the occurrence of complications such as parathyroid gland and laryngeal recurrent nerve injury. The techniques of vascular treatment are briefly described as follows: 1. The thyroid gland is a very vascular organ, and vascular management is the core of total thyroidectomy. We have established the “vascular skeletonization and migration coagulation method” to deal with the thyroid blood vessels, which can keep the field bleeding-free by dissecting the blood vessels in a closed state. The vessel to be dissected is first freed and skeletonized about 0.3 cm, and then coagulated about 0.3 cm from the proximal end with an ultrasonic knife or electric knife, and then cut at the centrifugal end. This method can safely coagulate arteries and veins with a diameter of 0.5 cm or less without ligation. In clinical practice, we found that most of the thyroid arteries and veins are below 0.5 cm in diameter. In the traditional method, the superior pole vessels are treated by separating and dissecting the superior thyroid arteries and veins and then ligating and cutting them close to the superior pole of the gland. The inferior pole vessels are treated by ligation away from the lower pole of the gland to avoid damage to the recurrent laryngeal nerve, severing the main trunk of the inferior thyroid artery or preserving part of the gland by intracapsular ligation and severing the branches of the inferior thyroid artery. Disadvantages: The upper parathyroid glands are supplied by the superior thyroid artery, and ligation of the superior pole vascular set can easily affect the blood supply to the upper parathyroid glands. The inferior parathyroid glands are supplied by the primary or secondary branches of the inferior thyroid artery, and ligation of the inferior thyroid artery trunk away from the inferior pole of the gland blocks the inferior parathyroid blood supply, while intracapsular ligation is bound to leave part of the gland. Technical improvement: The “vascular skeletonization transfer coagulation and dissection method” is used to coagulate and disconnect the primary branches of the superior thyroid artery and vein, the middle thyroid vein, the inferior thyroid vein, the secondary or tertiary branches of the inferior thyroid artery, and all other blood vessels entering and leaving the thyroid gland. 2.Thyroid dissection technique. Technical improvement: following the principle of minimally invasive, precise perineural dissection technique is used. The thyroid is dissected with non-invasive precision instruments such as thoracic forceps and nerve strippers close to the true peritoneum of the thyroid gland, from both sides to the middle isthmus. Traditional method: Dissect and free the thyroid gland between the true and false peritoneum with gauze balls and vascular forceps. Disadvantages: easy bleeding and damage to the parathyroid glands and the recurrent laryngeal nerve. 3. “Whole block excision” technique. Technical improvement: After freeing the bilateral lobes, the thyroid gland, isthmus and conus lobe are removed in one piece with an electric knife or ultrasonic knife close to the trachea. Rationale for the surgical design: The thyroid gland itself is an intact organ, but is artificially divided into the left and right lobes and the isthmus. Conventional method: The isthmus of the thyroid is separated bluntly with a curved hemostat in front of the trachea and cut off. The whole lobe of the thyroid is removed first, and then the other lobe is removed in the same way. Disadvantage: It is against the anaplastic principle of tumor surgery. 4. Parathyroid gland protection technique. Protection of the parathyroid glands is a priority in total thyroidectomy. The parathyroid glands are routinely dissected and exposed, and the blood supply of each parathyroid gland is carefully protected. The superior parathyroid gland is supplied by the superior thyroid artery, and the inferior parathyroid gland is supplied by the primary or secondary branches of the inferior thyroid artery, both of which have communicating branches. After revealing the parathyroid glands, the parathyroid glands are sharply separated from the true peritoneum with a sharp knife, and the hemostasis is stopped by the “fixed-point precise bipolar electrocoagulation method”, preserving the inferior parathyroid artery to ensure the blood supply to the parathyroid glands. 5. Recurrent laryngeal nerve protection technique. If the tumor is confined to the peritoneum of the thyroid gland, the laryngeal nerve will not be dissected; if the tumor infiltrates outside the peritoneum of the thyroid gland, the laryngeal nerve will be routinely dissected to reveal the laryngeal nerve. The laryngeal nerve is found via the inferior thyroid artery, and a silver nerve stripper is used to dissect and expose the laryngeal nerve from the inferior pole of the thyroid gland to the larynx where the laryngeal nerve enters the larynx, and the entire thyroid gland is removed under direct vision.