In primary hyperparathyroidism, one or more of the parathyroid glands are either enlarged or hyperactive. While medical management is possible for selected patients, surgical excision remains the only definitive treatment. Recently, improved radiographic techniques have fostered the widespread adoption of minimally invasive parathyroidectomy (MIP). Patients undergoing MIP benefit from improved cosmesis, reduced post-operative pain, a shorter length of stay, and a quicker return to pre-operative activity level. MIP is possible due to accurate pre- and intra-operative sestamibi localization of the overactive parathyroid glands, resulting in a more targeted operation. In this review of radioguided MIP, we detail the indications, operative technique, special situations, and look toward the future.