Aim of the study. In 1997 a personal minimally invasive video-assisted technique for parathyroidectomy was ideated. In this paper we analyzed the results on one hundred fifty nine cases of minimally invasive video-assisted parathyroidectomy (MIVAP). Methods. The procedure is a gasless technique which is based on a single central skin incision of 1.5 cm at the notch level. Through the incision small endoscopic instruments and a 30° 5 mm endoscope are inserted. The operative space is maintained by external retraction, without any gas insufflation. Results. MIVAP was successfully carried out in all but 12 patients.THe conversion rate was 7.5%. One recurrent laryngeal nerve palsy was registered (0.6%). and one case of persistent hyperparathyroidism. Two thyroid lobectomies were associated using the same minimally invasive access. Conclusion. MIVAP can boast the same results as traditional surgery offering additional advantages such as a better cosmetic result and less post-operative discomfort. Not all cases of PHPT can be suitable for MIVAP but in this series more than two thirds of cases were eligible for this approach.