Video-assisted thyroidectomy (VAT) has been proposed for small papillary thyroid carcinoma (PTC). We attempted to remove by the video-assisted approach also central neck lymph nodes that were unexpectedly found enlarged during VAT for PTC (VALD=video-assisted lymph node dissection). Seventy-seven patients underwent VAT for PTC. among them 26 patients underwent concomitant VALD. The procedure is performed by a totally gasless video-assisted technique through a single 1.5-2.0 cm central skin incision above the sternal notch. Dissection is performed under endoscopic vision using a technique very similar to conventional surgery. Only macroscopically enlarged lymph nodes were removed in 23 patients. In three additional patients a complete central neck dissection was carried out. There were 24 women and 2 men with a mean age of 39.4 +/- 13.4 years (range: 25-70). The mean number of removed lymph nodes was 2.8 +/- 2.0 (range: 1-9). Central neck dissection took about 15 minutes. Mean postoperative stay was 2.5 +/- 1.0 days (range:2-5). Seven transient postoperative hypocalcemias and one transient recurrent nerve palsy were registered. No other complication occurred. Final histology showed lymph node metasteses in 8 patients (macrometastases in 3) and reactive changes in all the others. Mean follow up was 13.5 +/- 4.6 months (range: 6-18). Postoperative sTg on LT4 was undetectable (<1ng/ml) in all the patients. Postoperative ultrasonography showed no residual thyroid tissue nor evidence of recurrence in all the patients. Mean pre-ablation 131I neck uptake (RAIU) was 2.6% (range: 0-9.1). All the patients considered the cosmetic result as excellent. VALD is feasible and safe. Despite some doubts still persist about the oncologic validity of this approach, no patients in this series showed persistent or recurrent disease also in case of lymph node metastases. Anyway, for definitive conclusions larger series and comparative studies are necessary.