One of the major problems in curing primary hyperparathyroidism is the ectopic parathyroid adenoma. This video demonstrates the successful operative management of four such patients. One patient had an undescended lower parathyroid adenoma at the carotid bifurcation, two others had adenomas lateral to the carotid sheath, and the final patient had a mediastinal parathyroid adenoma cured by sternotomy and thymectomy.