The vast majority of parathyroid adenomas are excised through a cervical incision. The ectopic ones, which are usually are localized in the mediastinum, are excised through sternotomy or thoracotomy. In recent years, it has been possible to resect this kind of adenomas with the use of video assisted thoracoscopic surgery (VATS), this technique offering the advantage of lower morbidity. We describe a case of a patient with end stage renal failure and tertiary hyperparathyroidism with ectopic parathyroid adenoma localized on the aortic arch, between the origin of the left carotid artery and left subclavian artery. The adenoma was excised using VATS and the patient was discharged on the first postoperative day following excision. CT scans, parathormone and Ca blood levels returned to normal. Pneumon 2003, 16(1):80-85.