Background. In 1998 we developed a technique for video-assisted thyroidectomy (VAT). In this paper we report on the entire series of patients who underwent VAT and discuss the results obtained. Methods. 192 patients were selected for VAT. Eligibility criteria were: thyroid nodules <= 35 mm in maximum diameter, estimated thyroid volume <= 20 ml, small (T1) ppaillary carcinomas, no previous neck surgery nor irradiation, no thyroiditis. VAT is a totally gasless video-assisted procedure. It is performed under endoscopic vision through a single 1.5-2.0 cm skin incision. Results. 204 VATs were attempted. In eight cases VAT was performed under loco-regional anesthesia. Seventy-seven lobectomies, 115 total thyroidectomies and 12 completion thyroidectomies were performed. Concomitant video-assisted central neck lymph node removal was ahieved in 26 cases. Final histology showed malignancy (differentiated thyroid carcinoma) in 85 cases. Postoperative complications included 4 transient recurrent nerve palsies, 23 transient hypocalcemias and 1 wound infection. Conversion rate was 2.4%. The cosmetic result was considered excellent by most of the patients. No evidence of recuurence was found in patients with malignant disease. Conclusions. In selected cases VAT has to be considered a valid option for surgical treatment of thyroid diseases.