Introduction: Thoracic parathyroid ectopia is an uncommon situation causing persistent/recurrent hyperparathyroidism. Minimally invasive techniques have been developed as an alternative to sternotomy. Here we present the Intercostal Video-Assisted Mediastinal Surgery (IVAMS), a new approach to perform ectopic mediastinal parathyroidectomy. It is an alternative to standard Standard Video-Assisted Thoracic Surgery (VATS) in order to simplify, if possible, the management of these infrequent surgical cases.

Methods: An ectopic gland was detected low in the mediastinum, behind the sternum and lung at the level of the 4th rib, in a patient with primary hyperparathyroidism. Anterior mediastinal space was entered through an intercostal window (15x10 mm). A standard 5-mm rigid scope with a 0 degree angle was used. The adenoma was succesfully removed by blunt dissection. The quick intraoperative PTH assay showed an insufficient decrement of PTH. Standard subtotal parathyroidectomy was performed through a neck incision.

Results: The immediate postoperative course was uneventful, the patient was discharged on the 2nd postoperative day. Six months later, in the follow-up, the patient remained normocalcemic (PTH: 6.1 pmol/L).

Conclusion: IVAMS is a safe and efficient approach to treat ectopic adenomas in the anterior mediastinum. It is simpler to perform and less invasive than standard VATS.