Endoscopic surgery is often considered to be 'minimally invasive surgery' in the light of recent technical developments. Endoscopic neck surgery, including thyroid and parathyroid surgery, has developed rapidly over the past 2 years. The various techniques of thyroid surgery, including sites of incision and procedures for creating adequate working space, are described here. The cosmetic benefits of endoscopic versus conventional open surgery were evaluated by questionnaires sent to two groups of patients. The lower invasiveness of endoscopic surgery in terms of operating time and amount of bleeding is also discussed. Endoscopic surgery with a new, totally gasless anterior neck skin lifting method, with which we have now had much experience, will be described and its advantages discussed.