Advantages of Unilateral Parathyroidectomy

Good results have been claimed by the proponents of the unilateral approach, with a decreased risk of hypocalcemia1 l-12-58'59 and vocal cord injury.58 Furthermore, focused parathyroidectomy has been suggested to lower costs, shorten hospital stay, and enhance recovery time.60"63 In agreement with these studies, a systematic review comparing unilateral with bilateral neck exploration indicated a tendency to favor the unilateral procedure.64

Recently, the first prospective, randomized, controlled trial comparing unilateral and bilateral neck exploration for PHPT was reported.22 Cure rate and costs did not differ between the two groups. However, the patients in the bilateral group had a higher incidence of early symptomatic hypocalcemia and lower serum calcium values on postoperative days 1 to 4 compared with patients in the unilateral group. In addition, in patients with PHPT due to a solitary parathyroid adenoma, unilateral neck exploration was associated with a shorter operative time. Complications occurred mainly in the bilateral group.22

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