<p>Ganglioneuromas are differentiated benign tumours derived from peripheral autonomic ganglia. They often arise from the posterior mediastinum or retroperitoneum with a median presenting age of 7&#xa0;years. There has been a shift away from thoracotomy towards the use of a minimally invasive approach for resecting these tumours. A 3-year-old boy, previously fit and well, presented with wheeze and shortness of breath. A chest X-ray revealed an incidental finding of a right-sided, apical opacification. Blood tests were unremarkable. Urinary catecholamines were negative. Further investigation with contrast computed tomography of the chest demonstrated a posterior mediastinal mass with dense foci of calcification not amenable to percutaneous biopsy, but in keeping with ganglioneuroma. Following multi-disciplinary team discussion, the decision was made for surgical resection. A right thoracoscopic technique was utilised with a four-port approach. There was careful dissection of the apical mass with diathermy and Ligasure™, with subsequent removal of a 2.6 by 1.6&#xa0;cm lesion. A chest drain was left in situ. The patient was discharged on post-operative day two. A partial right-sided Horner’s syndrome with mild ptosis was noted at discharge. Histologically, incomplete resection margins were noted due to proximity to subclavian vessels but showed low likelihood of recurrence. Thoracic magnetic resonance imaging at 3&#xa0;months post-resection revealed no residual mass. We aim to demonstrate ongoing evidence of safe use of a thoracoscopic approach for resection of neurogenic mediastinal tumours, even for small children with tumours close to major vasculature.</p>