After nearly a century of performing thyroidectomy essentially the way it was described by Theodore Kocher in the nineteenth century, the technique has quickly evolved. Parathyroidectomy has advanced as biochemical assays and physiologic imaging have become available. Minimally invasive and endoscopic thyroidectomy and parathyroidectomy can now be performed in many patients who benefit from the reduced dissection and smaller incisions associated with these approaches. Although many of the cosmetic, quality of life, and functional improvements have been proved, a better understanding of the procedure and the appropriate indications for its application will continue to develop even as the technique itself evolves, and as new approaches emerge.