Tehran University of Medical Sciences (TUMS) Academic Journal of Surgery 2423-3218 9 1 2026 10 25 50 56 ali dahmardeh shariati hospital Shirzad Nasiri Endocrine Surgery Division, Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Sam Moslemi Endocrine Surgery Division, Department of Surgery, Army Family Hospital, AJA University of Medical Sciences, Tehran, Iran Sina Sharghi Endocrine Surgery Division, Department of Surgery, Emam Ali Hospital, Alborz University of Medical Sciences, Karaj, Iran Aidin Yaghoobi Notash Colorectal Surgery Division, Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran 2026 06 29 Large parathyroid adenomas consist 1.5% of all adenomas. While minimally invasive parathyroidectomy is the method of choice with established advantages, surgeons prefer open surgery for large adenomas to reduce surgical risks. Here, we present a 41-year-old male with primary hyperparathyroidism due to large size parathyroid adenoma (3.2 cm) that was removed successfully by endoscopic trans-axillary parathyroidectomy. This presentation can guide surgeons to choose this minimally invasive technique, even for large adenomas. https://ajs.tums.ac.ir/index.php/ajs/article/view/347