Times are changing in endocrine surgery.Undoubtedly it is the progress of medical imaging that has modified the management of patients with primary hyperparathyroidism;especially through by assisting, modifying an improving surgical techniques.Today, the development and the reported efficacy of minimally invasive techniques have tempted many endocrinologists and surgeons to order some of these new minimally invasive techniques on patients undergoing first-time parathyroidectomy.Moreover, more than half the surgeons performing parathyroid surgery now know that bilateral parathyroid exploration is no longer the only option in all patients with primary hyperparathyroidism.Patients presenting with solitary adenoma must be considered as candidates for new limited surgical procedures.This emphasises the current role of preoperative localization studies in the surgical management of patients with primary hyperparathyroidism.Depending on the exact localisation acquired by combining anatomical and functioning imaging techniques, we are able to distinguish anterior and posterior localised adenomas.According to the exact localisation a different operative approach is offered to these patients.For anterior localised adenomas a mini-open approach is performed, for a posterior localised adenoma a pure endoscopic lateral neck approach is offered.The last one is nowadays in our centre performed totally robotic.In the early eighties John L.Dopmann stated that the only localisation study needed in a patient with untreated primary hyperparathyroidism was to localise an experienced parathyroid surgeon, now an experienced parathyroid surgeon is highly dependent on the results of the localisation studies performed to offer a minimal invasive approach to those patients.