With the advancements in endoscopic techniques, endoscopic thyroid surgery has become widely utilized. Currently, common approaches for endoscopic thyroid surgery include breast, oral vestibular, and transaxillary approach. Among them, endoscopic thyroidectomy by a gasless unilateral axillary approach has been highly recognized by many thyroid surgeons. This technique can meet patients' cosmetic needs while utilizing the natural space between neck muscles for operation to achieve the goal of minimally invasive surgery. Although the transaxillary gasless endoscopic thyroidectomy has become increasingly mature and standardized, several challenges need to be directly addressed in contralateral treatment of bilateral lobectomy during performing gasless unilateral axillary approach-endoscopic total thyroidectomy (GUA-ETT), such as avoiding tracheal obstruction, smoothly exposing the contralateral recurrent laryngeal nerve, and ensuring thorough clearance of contralateral central lymph nodes. In the authors' center, an improved three-step method for contralateral treatment and contralateral central lymph node dissection after unilateral thyroidectomy is proposed. To help thyroid surgeons master this technique, here, the authors provide a thorough explanation and sharing of the surgical methods, technical characteristics, operative techniques and nuances, as well as operative key points, difficulties, and operative experiences of the improved three-step method for contralateral treatment in GUA-ETT.