Ectopic parathyroid adenomas are very difficult to find and to remove. This videotape demonstrates the intraoperative management of four patients with ectopic parathyroid adenomas. One patient had an undescended lower parathyroid adenoma which was found at the carotid artery bifurcation. Two patients had ectopic parathyroid adenomas lateral to the carotid sheath in the neck. The final patient had a mediastinal parathyroid adenoma within the thymus gland which was cured by sternotomy and thymectomy. This videotape demonstrates the usefulness of preoperative localization studies.