With over 22 years of continuous development and innovation, totally endoscopic thyroidectomy has proved to be safe and feasible, and its minimal invasiveness and cosmetic benefit are beyond doubt. However, due to the narrow operation space of complete endoscopic thyroidectomy, rich blood supply of the thyroid gland, and being adjacent to the recurrent laryngeal nerve, superior laryngeal nerve, parathyroid glands, trachea, esophagus, lymphatic vessels and other important tissue structures, a series of serious associated complications may easily arise from unskilled operation. Particularly, some rare complications with low incidence in clinical practice, not specifically described in textbooks and rarely reported in domestic and foreign literature, such as delayed hemorrhage, chyle leakage, esophageal and tracheal injury, pneumothorax, CO2 embolism, are often overlooked and this results in delays in treatment. Once they occur, however, the consequences are always extremely serious. Therefore, based on the review of the literature and in combination with the clinical progress of thyroid surgery at home and abroad, the authors address the causes and prevention strategies for the rare complications of totally endoscopic thyroid surgery.