To summarize the experience of managing substernal goiter by totally endoscopic procedure and evaluate the curative effect, we analysed eight patients diagnosed as substernal goiter type I and treated with totally endoscopic technique via central routing approach during March 2011 to June 2013 in Beijing Shijitan Hospital retrospectively. The feasibility, safety and curative effect of this surgical technique were estimated. All the cases were successfully operated with the totally endoscopic procedure, and the pathological result showed that 6 were goiter and the other 2 were minimal papillary carcinoma. None of the patients suffered from any complication, and the median follow up time was 6 months (1-28 months). The totally endoscopic technique is a feasible, safe and cosmic one for managing substernal goiter type I.