Minimally invasive parathyroidectomy
A conventional parathyroidectomy entails bilateral neck exploration, identification of all four glands, and removal of the grossly enlarged gland(s). The development of accurate preoperative localization studies and a rapid intraoperative parathyroid hormone (ioPTH) assay has fostered the development of minimally invasive approaches to parathyroidectomy. A focused unilateral approach utilizes preoperative imaging to limit the dissection to one side. The abnormal gland is found and removed and after 10 to 15 minutes a postexcision blood sample is drawn and the PTH level is compared with a preexcision blood sample. A reduction of the PTH to 50% of the preoperative level and into the normal range predicts successful removal of all hyperfunctioning glands, and the surgery is terminated. If the PTH does not drop appropriately, then all four glands must be identified because the patient likely has multiglandular disease.