Robotic thyroidectomy has evolved from video-assisted endoscopic thyroidectomy (ET). The traditional open thyroidectomy is a highly effective surgical technique with minimal risks for recurrent laryngeal nerve injury or hypoparathyroidism. Endoscopic and robotic thyroidectomy techniques have been primarily developed to improve the cosmetic outcome. This is via either reducing the size of the incision in the neck as in original minimally invasive video-assisted thyroidectomy (MIVAT) or placing the incision in a remote and hence less or nonvisible area such as the axilla, chest, mouth, or the posterior neck. Remote access thyroidectomy via a robotic approach is more invasive as it involves more surgical dissection to gain access to the thyroid. Cosmetic gain needs to be considered in the context of risks and pitfalls as well as increased costs on operative resources and time. In this chapter, a review of the evolution of endoscopic and robotic thyroidectomy is provided along with the techniques involved. Strengths, limitations, and indications of the various approaches as well as risks and pitfalls are provided based on published literature.