Gasless endoscopic thyroidectomy via the subclavian approach is a modified surgical procedure that has gradually evolved from conventional cervical endoscopic-assisted surgery through instrument innovation, approach refinement, and optimization of the operative workflow. This technique establishes a stable working space without insufflation through a small subclavian skin-crease incision, an approach via the intermuscular plane between the sternal and clavicular heads of the sternocleidomastoid muscle, and a specialized suspension retractor. It reduces extensive dissection in the anterior neck and minimizes traction injury to structures such as the supraclavicular nerves. While ensuring the safety and oncological radicality of thyroid cancer surgery, this approach also offers minimally invasive and cosmetic advantages and may help reduce the risk of postoperative dysphagia and anterior neck discomfort. Its indications have gradually expanded from unilateral thyroid lobectomy with ipsilateral central compartment lymph node dissection to total thyroidectomy, bilateral central compartment dissection, and ipsilateral lateral neck lymph node dissection. Standardized implementation of this technique should emphasize key technical points, including precise incision placement, the plane of working space creation, identification of the recurrent laryngeal nerve and the external branch of the superior laryngeal nerve, in situ preservation or autotransplantation of the parathyroid glands, and adequate exposure of critical areas in the lower central compartment and lateral neck. The learning curve for unilateral procedures is relatively short, indicating good potential for wider adoption. However, more extensive procedures should be introduced progressively only after surgeons have fully mastered unilateral procedures, and surgical quality should be further improved through standardized training, strict control of indications, and accumulation of multicenter experience.