The creation and maintenance of surgical space is the first step of endoscopic thyroid surgery (ETS), which is important for subsequent operation and an initial challenge to beginners. The three main methods of maintaining the surgical space are gasless suspension, CO2 insufflation and hybrid technique. In this article, the authors summarize the common approaches of ETS, and with special emphasis on the anterior chest approach, describe the methods for surgical space creation and maintenance as well as precautions and major complications.