The location and removal of ectopic mediastinal glands represents one of the major problems in parathyroid surgery. Minimally invasive surgery for such indications has been evaluated to reduce the high morbidity and long reconvalescence of standard open approaches. The recent introduction of robotic surgical systems may offer new options for this purpose. A literature review of reports on thoracoscopic resections of mediastinal parathyroids is presented. The potential of a robotic surgical system for this indication is discussed. Between 1994 and 2002, 19 groups have reported on thoracoscopic parathyroidectomy in a total of 38 patients. In seven (18%) patients thoracoscopic identification had to be radioisotopically guided. Two (5%) conversions to an open approach were necessary. There were three (8%) moderate complications. Based on available data, video-assisted thoracic surgery (VATS) is a less invasive, effective and safe procedure for the removal of ectopic mediastinal parathyroids and can therefore be recommended as the standard approach. However, preoperative localization of the ectopic gland is a prerequisite. Surgical robotic systems have the potential to make this type of procedure even more accurate and thus safe.