Transoral endoscopic thyroidectomy (TOET) is a type of natural orifice transluminal endoscopic surgery (NOTES). In 2008, Witzel et al. first attempted transoral endoscopic thyroidectomy through the oral floor in fresh cadavers and live pigs. Professor Wang Cunchuan in China was the first to propose the three-port transoral endoscopic thyroidectomy vestibular approach (TOETVA) internationally. Currently, this is the most widely used transoral endoscopic approach for thyroid surgery, with the main advantages of minimal damage to the oral floor structures and greater instrument maneuverability. It leaves no visible scars on the skin surface, meets the dual requirements of disease cure and aesthetic appearance, and ensures privacy protection. TOETVA provides a top-down view, which, due to its natural visual advantage, resolves the problem of low-level lymph node dissection in the central region. Therefore, TOETVA is the preferred surgical procedure for cases of differentiated thyroid cancer with central lymph node metastasis. Since its introduction in 2013, TOETVA has been initially developed in China, and multiple centers started attempting it in 2015. To date, there are already hundreds of institutions in China capable of performing this procedure. The technical key points and challenges of TOETVA mainly include the establishment and maintenance of space, exposure and protection of the recurrent laryngeal nerve, identification and preservation of the parathyroid glands, and lymph node dissection. Compared to the transthoracic approach, transoral endoscopic thyroid surgery has a steeper learning curve, typically requiring 40-50 cases to overcome. In comparison to open surgery and other scarless endoscopic thyroidectomy approaches, in addition to common complications such as bleeding, nerve injury, parathyroid injury, and flap injury, transoral endoscopic thyroid surgery has the following special complications: mental nerve injury, infection, CO₂ gas embolism, pleural injury, and abnormal functional reactions in the mandibular region, among others. TOETVA has shown good tumor control and aesthetic outcomes, experiencing rapid development over the past decade. As part of the NOTES surgical system, it represents the trend of endoscopic and minimally invasive surgery. The future focus is on scientific application and promotion of TOETVA technology, with strict adherence to surgical indications being of utmost importance. Only by adhering to the basic principles of "treating the disease first, preserving function second, and considering aesthetics third" can TOETVA be scientifically and standardizedly promoted. Additionally, teaching hospitals should take the lead in actively promoting the dissemination of guidelines and consensus, while continually demonstrating surgical procedures in clinical practice. Expanding indications, improving surgical techniques, and developing new technologies are the hotspots of future research in TOETVA. The surgical indications for TOETVA are not absolute, and as the operator's skills improve, the surgical difficulty can gradually increase. However, it should be noted that any procedure beyond the current guidelines and expert consensus is considered unconventional surgery. Currently, the expansion of indications for TOETVA is mainly represented by lateral neck dissection, but dissection of level Ⅱ lymph nodes remains challenging. Therefore, there is controversy regarding whether TOETVA can achieve a radical effect with lateral neck dissection. This article provides an overview of the current status and prospects of this approach based on domestic and international literature and our center's relevant experience.