Unilateral and bilateral surgery for parathyroid disease

The goal of parathyroid surgery, extirpation of all disease with the least possible patient morbidity, is the same regardless of the approach. According to this aim, it may be difficult for the neophyte surgeon to determine which approach is most appropriate. Bilateral exploration offers the potential of identifying and removing all disease with a single operation, whereas unilateral surgery carries the promise of decreased morbidity. Unfortunately, a cursory review of the literature is not as helpful as one would expect. The sheer volume of studies on parathyroid surgery can prove to be an insurmountable review task for any active clinician: the PubMed National Library of Medicine (available at: http://www.ncbi.nlm.nih.gov/entrez) has 2347 citations between 1993 and 2003. Further, numerous contradictory reports fail to define accurately the nuances of clinical management. In the end, the choice of technique may have more to do with surgeon preference and experience than with science. As Edward D. Churchill stated in 1931, "The success of parathyroid surgery must lie in the ability of the surgeon to know a parathyroid gland when he sees it.