Conclusion and Future Aspects

High-quality preoperative localization procedures such as sestamibi scintigraphy and ultrasonography as well as the introduction of intraoperative monitoring for intact PTH serum levels have facilitated the treatment of patients with solitary parathyroid adenoma. Minimal invasive parathyroidectomy is the ideal surgical treatment for patients with PHPT due to a single parathyroid adenoma. In a survey of the members of the International Association of Endocrine Surgeons, more than half of them indicated that they currently perform minimal invasive parathyroidectomy and use the technique for an average of 44% of the patients with PHPT.65 Several questions need to be addressed in the future, such as the role of video-assisted parathyroidectomy compared to a focused conventional approach, and the precise role for parathyroidectomy under local anesthesia. Furthermore, although a 5-year follow-up has shown that measurement of intraoperative PTH can predict long-term operative success,66 long-term data from prospective, randomized trials are necessary to provide the answer to a possible difference in long-term normocalcemia between the different surgical strategies.

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