Abstract: Objective To investigate the safety and feasibility of the most inferior approach, anterograde dissection and thermal insulation protection of the cervical recurrent laryngeal nerve (RLN) in thyroid cancer surgery. Methods A retrospective analysis was performed on 53 patients with thyroid cancer who underwent right thyroidectomy and lymph node dissection in the right central region from February 2018 to January 2019. There were 24 cases with traditional method and 29 cases with new method. The changes of electrophysiological signals of the recurrent laryngeal nerve, postoperative pronunciation, incidence of postoperative hypocalcemia and the number of lymph node metastases in the central region of the neck were statistically analyzed. Results In the traditional group, there were 6 cases in which the amplitude of the RLN electrophysiological signal decreased by ＞50%, and 1 cases in the new method group, there were statistically significant differences between the two groups (P＜0.05). There were 3 cases hypocalcaemia after the surgery in the traditional group and 4 cases in the new method group, there were no statistically significant differences between the two groups (P＞0.05). There were 14 (58.3%) cases lymph nodes in the central region of the traditional group, and 18 (62.1%) cases in the new method group, there were no statistically significant differences between the two groups (P＞0.05). There were 3.1±1.8 lymph node dissections in the central zone in the traditional group and 5.0±2.4 in the new method group, the difference between the two groups was statistically significant (P＜0.05). Conclusion The technique of the most inferior approach and thermal insulation protection of recurrent laryngeal nerve is benefit to protect the RLN and improve the safety in thyroid cancer surgery.