A 48 year old woman suffering from primary hyperparathyroidism: pre-operative MIBI scintiscan shows an enlarged lower left parathyroid gland. The patient is under general anesthesia. A 15 mm horizontal incision is performed 2 cm above the sternal notch: the mid-line is divided longitudinally. Strap muscles are retracted using 2 modified small army navy retractors which maintain the operative space during the procedure. A 30 degree, 5 mm endoscope is inserted through the incision. Conventional instruments (2 mm), such as spatulas and forceps, are used to carry out the procedure. The middle vein is divided between titanium clips to give access to the thyroid space. Once identified the recurrent laryngeal nerve, the exploration of the neck is performed until the enlarged parathyroid is recognized: it proves to be a lower left adenoma according to scintiscan, its anatomical relationships with inferior thyroid vessels are well visible. After its gentle dissection it is extracted through the cervical incision, avoiding the rupture of its capsule: vascular clips are used to achieve haemostasis on the gland pedicle. The mid line and platysma are sutured and the skin closed by sin glue. No drainage is necessary. The operation lasted 22 minutes and was facilitated by using a quick parathyroid hormone assay.