Parathyroidectomy is usually a straightforward technique when the target gland has been accurately determined. Surgical excision is usually through a small midline incision. With the advent of video assisted surgery, trials have been made to use this technique in parathyroidectomy. In this article the authors compared their results using a classical approach in 58 patients and a video assisted surgery in 54. The major difference was the size and site of the incision: being a midline collar 3-4 cm long incision in the classical approach and a 2-cm lateralised incision in the endoscopic approach. The operative time was longer in the endoscopic approach; the duration of surgery was longer in the video assisted surgery. The end results and complication rates were not statistically significant. The authors conclude that the minimally invasive surgery is a satisfactory approach and was positively viewed by the surgeons. However, we must note that the main difference was an average 1-cm difference in the incision, a longer operation time and the necessity of recurrent laryngeal nerve monitoring. The total cost-effectiveness must be considered: extra equipment (endoscope, camera, special instruments, monitoring), extra operative time and special training for surgeons. For the time being it seems to be an attractive technique but it may not yet be time to replace the classical approach.