A 23-year-old woman was noted to have an elevated serum calcium to 12.7mg. She was 27 weeks pregnant and had experienced eclampsia on her first pregnancy. Her parathormone level was 57pg/cc (normal 65) which was consistent with hyperparathyroidism in the face of an elevated calcium. Ultrasound revealed an enlarged right parathyroid in the tracheoesophageal groove (see parathyroid embryology and anatomy) posterior to the inferior right thyroid lobe. Nuclear scan and localization (sestimibi, see minimally invasive parathyroidectomy, VID 992) were not done because of the pregnancy. The patient had no secondary signs of hyperparathyroidism. Because of the history of eclampsia and suppression of fetal parathyroid development, the patient was taken for video-assisted, minimally invasive parathyroidectomy (see also minimally invasive parathyroidectomy, VID 992). The table position, flexed at knees and hips and extended at the neck, is shown.