A 32 year old woman presenting with a 2.5 cm follicular tumor is undergoing a right hemithyroidectomy. A superficial bilateral cervical block is performed using lidocaine and mepivacaine. The same anesthetic is also injected under the skin along the incision line. Remifentanil i.v. is used for sedation. A 15-mm horizontal incision is performed 2 cm above the sternal notch: the mid-linea is divided longitudinally. The strap muscles are retracted using 2 modified small army navy type retractors which maintain the operative space during the procedure. A 30 degree, 5-mm endoscope is inserted through the incision. The middle vein is divided by means of a Harmonic Scalpel. The upper pedicle is then divided using the same device and the recurrent laryngeal nerve is searched for and gently dissected. The upper portion of the gland is extracted. The operation is now performed as in open surgery. The lobe is freed from the trachea: it is very important to check once again the laryngeal nerve at this point in time, so to avoid its injury before the final step. The isthmus is then dissected from the trachea and divided. The linea alba and platysma are sutured and the skin closed by skin glue. The operation lasted 38 minutes.