Parathyroidectomy

Parathyroidectomy is definitive treatment for sporadic, primary hyperparathyroidism with cure rates as high as 98 % at expert centers. We explore the predictive value of preoperative localizing studies including ^99mTc-sestamibi scan, ultrasound, and four-dimensional CT scan. Operative technique for bilateral neck exploration is described with special attention given to anatomic principles. While there are multiple techniques for limited exploration -defined as a unilateral, image-directed parathyroidectomy involving an incision measuring 2.5 cm or less -we describe the lateral mini-incision approach. Although uncommon, complications of parathyroidectomy include hematoma, hypocalcemia, permanent hypoparathyroidism, nerve injury, and operative failure. Finally, we address the advantages, disadvantages, and controversies of four-gland versus limited exploration.