To define a new procedure as safe and effective, we need to demonstrate that both its complication rate and its success rate are comparable or better than those obtained by traditional surgery. This is particularly difficult when comparing endoscopic parathyroidectomy to traditional parathyroidectomy, which has a success rate of 95%12 with a negligible complication rate. These complications include recurrent nerve palsy and hypoparathyroidism. Hypoparathyroidism is particularly rare, probably due to minimal manipulation required by endoscopic surgery and improved visualization. This is in contrast to the traditional approach of extensive bilateral neck exploration and sometimes frequent biopsy. Thus, the incidence of postoperative hypocalcemia, either transient or permanent, is significantly less after minimally invasive parathyroidectomy.13 This rate is similar to that of open unilateral exploration. The use of qPTHa also avoids the unnecessary removal of enlarged glands with normal function and minimizes postoperative hypoparathyroidism.14

Recurrent nerve palsy is rare in all the series with rate of 1% or lower both in traditional operations15 and in endoscopic approaches.1116

There is no evidence of an increased rate of persistent disease after the adoption of minimally invasive parathyroidectomies. Our persistence rate is lower than 2% in almost 300 cases; other published rates of persistent disease also do not exceed 4% to 5%;,n,i6-i8 which is similar to the results obtained by traditional surgery.1215 Nevertheless, it should be noted that patients undergoing minimally invasive parathyroidectomies are a selected group and this could bias the results.

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