BackgroundThe extra-cervical lateral route endoscopic thyroidectomy (LRET) approaches such as the trans-axillary, breast and axillo-breast approaches are proved to be safe, feasible, esthetic, highly effective. The inherent difficulty and long learning curve of these techniques prevents its widespread application.MethodsBenefiting from the experience of more than 5 years in LRET approaches with CO2insufflation, the authors developed ten surgical key steps and a critical view of safety (CVS) for performing thyroid lobectomy via LRET approaches. A detailed description and a video of the surgical technique is provided.ResultsApplication of these structured key steps and CVS was feasible and effective in achieving thyroid lobectomy in all selected cases with unilateral goiter up to 8 cm, even in cases with thyroiditis or controlled toxic adenoma, without any adverse events and with shorter operative time than the non-structured surgical technique.ConclusionThe described ten key steps and CVS are conclusive, applicable, easy to learn. Our video could act as a guide for promoting the standardized, safe, and wide application of LRET techniques.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00268-023-06977-8.