Introduction: Ectopic parathyroid adenomas can be located within the residual thymic tissue, in the aortopulmonary window (APW), in the posterior mediastinum, or within the parenchyma of the thyroid gland. Only 2% of them are not accessible through standard cervical incision and require a thoracic approach. 1 Recently, a number of minimally invasive strategies for their management have emerged, including video-assisted thoracoscopic surgery (VATS) and video-assisted mediastinoscopy (VAM). We report the case of an ectopic parathyroid adenoma located in the APW, which was successfully managed by VAM under continuous intraoperative neuromonitoring to ascertain the function of the left recurrent laryngeal nerve (LRLN).