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. We also describe unilateral exploration and selective/targeted exploration. Additionally, we discuss intraoperative adjuncts such as intraoperative parathyroid hormone (PTH) measurements and radioguided parathyroidectomy. 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.