Current surgical techniques: Surgery for hyperparathyroidism

Management of parathyroid disease remains primarily surgical. In experienced hands, cure rates of 95% to 98% for primary hyperparathyroidism can be expected. Knowledge of embryology and experience with the pertinent anatomy is of paramount importance in achieving a consistently high success rate. Preoperative localization and the extent of surgery (unilateral vs bilateral) are the main areas of controversy. New developments include a rapid bioassay that allows for intraoperative determination of parathyroid hormone levels. This procedure may help the surgeon determine when the hyperactive gland has been removed. Although localization studies are imperative in secondary procedures, their role in primary exploration is controversial. If one is willing to consider a unilateral exploration as adequate, then preoperative studies will contribute to the success of that procedure. The the cost-benefit ratio, however, has not been proven to be favorable. Ultimately, surgical preference and expertise determine the treatment options.