Background: In the past several decades we have seen that most cervicomediastinal goiters (CMGs) can be removed through a cervical lower collar incision, but in some circumstances a median sternotomy or a thoracotomy is mandatory. In the last few years, video-assisted thyroidectomy (VAT) has been developed, and the indications are that its usage is becoming more widespread. This study aimed to evaluate the technical feasibility and safety of VAT for CMG. Patients and Methods: Over a 5-year period (2009-2014), 602 patients underwent conventional thyroidectomy (CT), and 356 cases underwent VAT in the Department of General Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. Among all those patients, 33 (3.4%) were diagnosed with CMGs and operated on. These patients were divided into two groups: the CT group included 18 patients, and the VAT group included 15 patients. The incision length, operative time, blood loss, hospitalization time, and postoperative complications were recorded and analyzed. Results: All 15 procedures in the VAT group were performed successfully with the help of endoscopy, whereas for 2 of the 18 patients (11.1%) in the CT group, a partial median sternotomy had to be done due to poor exposure and abnormal hemorrhage. Significant differences in the incisional length, operative time, and intraoperative blood loss occurred between the CT and VAT groups. The patients who underwent VAT had a better cosmetic result without going through an additional incision. There was no difference in the resected goiter weight between the two groups. The patients who underwent VAT recovered more rapidly and had a shorter hospitalization time than those in the CT group (P=.000). No significant difference was found in postoperative complications between the two different approaches. During a mean follow-up through 28 months (range, 3-66 months), no recurrence occurred. Conclusions: VAT is a safe and feasible approach for patients with CMG. The procedure has relatively satisfactory cosmetic effect and faster postoperative recovery.