Directed Parathyroidectomy

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Abstract
CHALLENGES IN the operative treatment of primary hyperparathyroidism (PHPT) relate to recognition of multiglandular disease (MGD) and location of ectopic glands. For decades surgeons have successfully met these challenges with routine bilateral neck exploration (BNE). The availability of sensitive preoperative imaging techniques and an accurate intraoperative parathyroid hormone (IOPTH) assay challenges this paradigm. These advances facilitate a less extensive operation in patients with uniglandular disease (UGD). To date, directed parathyroidectomy (DP) yields results comparable to BNE.1,2 In addition, DP may prove beneficial by reducing operative time, length of hospitalization, and convalescent period.3,4 The purpose of this study was to evaluate the efficacy of an algorithm that includes routine preoperative imaging and IOPTH monitoring and is designed to attempt DP in all patients with PHPT.