Parathyroid surgery has evolved from a surgery that aimed to improve the medical condition of symptomatic patients with “stones, bones, and abdominal groans” to a surgery being performed for a more silent disease with manifestations including hypercalcemia, osteoporosis, and nephrocalcinosis. In parallel, advances in imaging and preoperative localization have allowed for a transition from systematic bilateral exploration of all four parathyroid glands to focused parathyroidectomy. The principle surgical approach has remained midline cervical access between the strap muscles, even though “minimally invasive” approaches have been described. To ensure the success of the surgery and to minimize failed exploration, tools such as frozen section analysis and intraoperative parathyroid hormone (PTH) assays among others have been described. Complications of parathyroid surgery are rare with recurrent laryngeal nerve palsy and hungry bone syndrome being the most common and important ones.