Purpose: With increasing adoption of Trans Oral Endoscopic thyroidectomy (TOETVA), prevention of complications such as parathyroid injury and postoperative hypoparathyroidism has become increasingly important. The combination of enhanced endoscopic visualization and indocyanine green (ICG) angiography offers a potential method for accurate identification of parathyroid glands and assessment of their vascularity and viability. Objective: To evaluate the effectiveness of ICG angiography in identifying parathyroid glands, assessing their vascularity and viability during TOETVA. Methodology & Results: This prospective observational study included 115 patients undergoing TOETVA. Parathyroid glands were identified intraoperatively using standard endoscopic visualization and confirmed with ICG angiography. ICG was used to delineate vascular anatomy and assess perfusion of the parathyroid glands. Based on fluorescence intensity and perfusion patterns, glands were graded from 0 to 2 as per viability. ICG angiography was repeated at the end to reassess gland perfusion and guide the need for autotransplantation. Combined use of high-definition endoscope and ICG angiography enabled accurate identification and confirmation of parathyroid glands, significantly reducing inadvertent injury. The incidence of transient and permanent hypoparathyroidism was low, less than 3% and 1% of patients respectively, which was statistically significant compared with historical controls. Conclusion: The use of ICG angiography in conjunction with enhanced endoscopic visualization during TOETVA provides a reliable method for identifying parathyroid glands and assessing their viability. This technique significantly reduces the incidence of parathyroid injury and postoperative hypoparathyroidism and may be considered a valuable adjunct in endoscopic thyroid surgery.