The aim of the study was to present evolution of the technique of minimally invasive video-assisted thyroidectomy, its advantages, limitations and possible complications related to the method.Material and methods. Minimally invasive video-assisted thyroidectomy (MIVAT) is characterized by a unique central incision of 1.5 cm, 2 cm above the sternal notch. The operative space is maintained by means of an external retraction: no gas insufflation is utilized. Potential complications of Minimally Invasive Video-assisted Thyroidectomy (MIVAT) are roughly the same as in open surgery.Results. Since June 1998 to March 2008 1524 patients underwent a minimally invasive video-assisted thyroidectomy. Complications were represented by transient monolateral recurrent nerve palsy in 38 cases (2.4%), definitive monolateral recurrent nerve palsy in 18 cases (1.1%), bilateral transient recurrent nerve palsy in 2 cases. Fifty five patients exhibited a hypoparathyroidism, which corresponds to 5.1% of the 1059 total thyroidectomies performed, but only 5 complained of a permanent hypocalcemia which necessitated a substitutive therapy, thus reducing the rate of permanent hypoparathyroidism to 0.4%. We registered in two cases of postoperative bleeding requiring re-operation; wound sepsis occurred in three cases.Conclusions. MIVAT unlike other minimally invasive endoscopic techniques proposed for thyroidectomy, reproduces the standard operation and does not introduce any modification of the traditional technique and in our series total complication rate resulted similar to that described in literature for standard thyroidectomy in large series. As long as these criteria are carefully respected one need not to be concerned that these techniques might increase the complication rate.