Based on gross anatomical observations and clinical experience, our center proposed the concept of mesothyroid excision in 2014. We have consistently applied this technique to guide open thyroidectomy and central compartment neck dissection for malignant thyroid tumors. The advantage of this technique is its ability to achieve a more thorough en bloc removal of the central compartment lymph nodes while ensuring the safety of the recurrent laryngeal nerve. In recent years, transaxillary endoscopic thyroid surgery has been rapidly promoted in our country. Our center began performing transaxillary endoscopic thyroid surgery in 2019 and made improvements to the gasless transaxillary endoscopic thyroid surgery under the theoretical guidance of our previous mesothyroid excision technique. To facilitate thyroid surgeons in mastering this technique, this article disassembles and assembles the theory into the "five-settlement method" of surgical operation with detailed explanations.