Extracapsular lobectomy or total thyroidectomy are the surgical techniques normally used to deal with either benign or malignant thyroid diseases needing surgery. Both the well-known pathogenesis of benign surgical pathology and the positive role of post-operative radiometabolic treatment for differentiated carcinomas justify this surgical approach. Of course a complete understanding of anatomic structures and skilled operative techniques are necessary. The thyroid's parenchyma preventive extracapsular devascularization allows a strictly bloodless operative field, which makes it easier to preserve both the superior and inferior laryngeal nerves and the parathyroid glands of both sides. Therefore this procedure can be primarily considered a "vascular" technique. Our surgical technique is thoroughly described here, stressing anatomical landmarks and surgical steps, and maintaining awareness of pathophysiological implications and related operative choices.