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.


1. Mandl F. Therapeutischer Versuch bei Ostitis Fibrosa generalisata Mittels Exstirpation eines Epitehelkorperchen Tumors. Wien Clin Wochenschr 1925;50:1343.

2. Bloch MA, Frame B, Jackson CE, et al. The extent of operation for primary hyperparathyroidism. Arch Surg 1974; 109:798.

3. Paloyan K, Lawrence AM, Oslapas R, et al. Subtotal parathyroidectomy for primary hyperparathyroidism: Long-term results in 292 patients. Arch Surg 1983;118:425.

4. Johansson H, Granberg PO, Tibblin S, et al. Scandinavian study of the parathyroid surgical activity in 1975. Acta Chir Scand Suppl 1979;493:66.

5. Wang CA. Surgical management of primary hyperparathyroidism. Curr Probl Surg 1985:22:1.

6. Tibblin S, Bondeson A-G, Ljungberg O. Unilateral parathyroidectomy in hyperparathyroidism due to single adenoma. Ann Surg 1982; 195:245.

7. Harrison ST, Duarte B, Reitz RE, et al. Primary hyperparathyroidism four- to eight-year postoperative follow-up demonstrating persistent functional insignificance of microscopic parathyroid hyperplasia and decreased autonomy of parathyroid hormone release. Ann Surg 1981; 194:429.

8. Roth SI, Gallagher MJ. The rapid identification of "normal" parathyroid glands by the presence of intracellular fat. Am J Pathol 1976:84:521.

9. Ljungberg O, Tibblin S. Perioperative fat staining in frozen sections in primary hyperparathyroidism. Am J Pathol 1979:95:633.

10. Bondeson A-G, Bondeson L, Ljungberg O, Tibblin S. Fat staining in parathyroid disease: Diagnostic value and impact on surgical strategy—Clinicopathologic analyses of 191 cases. Hum Pathol 1985;16:1255.

11. Tibblin S, Bondeson A-G, Bondeson L, Ljungberg O. Surgical strategy in hyperparathyroidism due to solitary adenoma. Ann Surg 1984; 200:776.

12. Tibblin S, Bizard JP, Bondeson A-G, et al. Primary hyperparathyroidism due to solitary adenoma: A comparative multicenter study of early and long-term results of different surgical regimens. Eur J Surg 1991:157:511.

13. Thompson NW. Localization studies in patients with primary hyperparathyroidism. Br J Surg 1988,75:97.

14. Thompson NW, Eckhauser FE, Harness JK. The anatomy of primary hyperparathyroidism. Surgery 1982;92:814.

15. Uden P, Aspelin P, Berglund J, et al. Preoperative localization in unilateral parathyroid surgery. Acta Chir Scand 1990:156:29.

16. Bergenfelz A, Forsberg L, Hederstrom E, Ahren B. Preoperative localization of enlarged parathyroid glands with ultrasonic-guided fine-needle aspiration for parathyroid hormone assay. Acta Radiol 1991; 32:403.

17. Billotey C, Aurengo A, Najean Y, et al. Identifying abnormal parathyroid glands in the thyroid uptake area using technetium-99m sestamibi and factor analysis of dynamic structures. J Nucl Med 1994; 35:1631.

18. Taillefer R. 99mTc sestamibi parathyroid scintigraphy. In: Freeman EM (ed), Nuclear Medicine Annual, 1995. New York, Raven Press, 1995, p 51.

19. Norman J, Chheda H, Farrell C. Minimally invasive parathyroidectomy for primary hyperparathyroidism: Decreasing operative time and potential complications while improving cosmetic results. Am Surg 1998:64:391.

20. Bergenfelz A, Tennvall J, Valdemarsson S, et al. Sestamibi versus thallium subtraction scintigraphy in parathyroid localization: A prospective comparative study in patients with predominantly mild primary hyperparathyroidism. Surgery 1997:121:601.

21. McBiles M, Lambert AT, Cote MG, et al. Sestamibi parathyroid imaging. Semin Nucl Med 1995:25:221.

22. Bergenfelz A, Lindblom P, Tibblin S, Westerdahl J. Unilateral versus bilateral neck exploration for primary hyperparathyroidism: A prospective randomized controlled trial. Ann Surg 2002;236:543.

23. Lee VS, Wilkinsson RH, Leight GS Jr, et al. Hyperparathyroidism in high-risk surgical patients: Evaluation with double-phase technetium-99m sestamibi imaging. Radiology 1995:197:627.

24. Bergenfelz A, Lundstedt C, Stridbeck H, Ahrdn B. Large vein sampling for intact parathyroid hormone in the preoperative localization of enlarged parathyroid glands. Acta Radiol 1992;33:528.

25. Bergenfelz A, Algotsson L, Roth B, et al. Side localization of parathyroid adenomas by simplified intraoperative venous sampling for parathyroid hormone. World J Surg 1996:20:358.

26. Nussbaum SR, Thompson AR, Hutcheson KA, et al. Intraoperative measurement of parathyroid hormone in the surgical management of hyperparathyroidism. Surgery 1988;104:1121.

27. Irvin GL, Dembrow VD, Prudhomme DL, et al. A new approach to parathyroidectomy. Ann Surg 1994;219:574.

28. Bergenfelz A, Norden NE, Ahren B. Intraoperative fall in plasma levels of intact parathyroid hormone after removal of one enlarged gland in hyperparathyroid patients. Eur J Surg 1991,147:109.

29. Bergenfelz A, Isaksson A, Ahren B. Intraoperative monitoring of the intact PTH during surgery for primary hyperparathyroidism. Langenbecks Arch Chir 1994;379:50.

30. Ryan MF, Jones SR, Barnes AD. Modification to a commercial immuno-radiometric assay permitting intraoperative monitoring of parathyroid hormone levels. Ann Clin Biochem 1990;27:65.

31. Irvin GL, Dembrow VD, Prudhomme DL. Operative monitoring of parathyroid gland hyperfunction. Am J Surg 1991;162:299.

32. Carneiro DM, Irvin GL III. New point-of-care intraoperative parathyroid hormone assay for intraoperative guidance in parathyroidectomy. World J Surg 2002;26:1074.

33. Miura D, Wada N, Arid C, et al. Does intraoperative quick parathyroid hormone assay improve the results of parathyroidectomy? World J Surg 2002;26:926.

34. Agarwal G, Barakate MS, Robinson B, et al. Intraoperative quick parathyroid hormone versus same-day parathyroid hormone testing for minimally invasive parathyroidectomy—A cost-effectiveness study. Surgery 2001;130:963.

35. Palmer M, Bergstrom R, Akerstrom G, et al. Survival and renal function in untreated hypercalcemia. Lancet 1987;1:59.

36. Palmer M, Adami HO, Bergstrom R, et al. Mortality after surgery for primary hyperparathyroidism: A follow-up of 441 patients operated on from 1956-1979. Surgery 1987;102:1.

37. Ronni-Svivula H. Causes of death in patients previously operated on for primary hyperparathyroidism. Ann Chir Gynaecol 1985;74:13.

38. Hedback G, Tisell LE, Bengtsson bA, et al. Premature death in patients operated on for primary hyperparathyroidism. World J Surg 1990; 14:829.

39. Pyrtek LJ, Belkin M, Bartus S, Schweizer R. Parathyroid gland exploration with local anesthesia in elderly and high-risk patients. Arch Surg 1988;123:614.

40. Bergenfelz A, Algotsson L, Ahren B. Surgery for primary hyperparathyroidism performed under local anaesthesia. Br J Surg 1992;79:931.

41. Chapuis Y, Icard PH, Fulla Y, et al. Parathyroid adenomectomy under local anaesthesia with intraoperative monitoring of UcAMP and/or 1-84 PTH. World J Surg 1992;16:570.

42. Lafferty FW, Hubay CA. Primary hyperparathyroidism: A review of the long-term surgical and nonsurgical morbidities as a basis for rational approach to treatment. Arch Intern Med 1989; 149:789.

43. Jansson S, Tisell LE, Linstedt G, Lundberg PA. Disodium pamidronate in the preoperative treatment of hypercalcemia in patients with primary hyperparathyroidism. Surgery 1991; 110:480.

44. Karstrup S, Transbol I, Holm HH, et al. Ultrasound-guided chemical parathyroidectomy in patients with primary hyperparathyroidism: A prospective study. Br J Radiol 1989;62:1037.

45. Chapuis Y, Fulla Y, Bonnichon P, et al. Values of ultrasonography ses-tamibi scintigraphy and intraoperative measurement of 1-84 PTH for unilateral neck exploration of primary hyperparathyroidism. World J Surg 1996:20:835.

46. Inabnet WB, Fulla Y, Richard B, et al. Unilateral neck exploration under local anesthesia: The procedure of choice for asymptomatic primary hyperparathyroidism. Surgery 1999:126:1004.

47. Chen H, Sokoll LJ, Udelsman R Outpatient minimally invasive parathyroidectomy: A combination of sestamibi-SPECT localization, cervical block anesthesia, and intraoperative parathyroid hormone assay. Surgery 1999; 126:1016.

48. Ditkoff BA, Chabot J, Feind C, et al. Parathyroid surgery using monitored anesthesia care as an alternative to general anesthesia. Am J Surg 1996:172:698.

49. Harness JK, Ramsberg SR, Nishiama RH, et al. Multiple adenomas of the parathyroids: Do they exist? Arch Surg 1979; 114:468.

50. Henry JF. Defechereux T, Gramatic L, et al. Minimally invasive videoscopic parathyroidectomy by lateral approach. Langenbecks Arch Surg 1999;384:298.

51. Gauger PG, Reeve TS, Delbridge LW. Endoscopically assisted minimally invasive parathyroidectomy. Br J Surg 1999:86:1563.

52. Miccoli P, Berti P, Conte M, et al. Minimally invasive video-assisted parathyroidectomy: Lesson learned from 137 cases. J Am Coll Surg 2000;191:613.

53. Dralle H, Lorenz K, Nguyen-Thanh P. Minimally invasive videoassisted parathyroidectomy-selective approach to localized single gland adenoma. Langenbecks Arch Surg 1999:384:556.

54. Miccoli P, Bendinelli C, Berti P, et al. Video-assisted versus conventional parathyroidectomy in primary hyperparathyroidism: A prospective randomized study. Surgery 2000:128:121.

55. Henry JF, Raffaelli M, Iacobone M, Volot F. Video-assisted parathyroidectomy via the lateral approach vs conventional surgery in the treatment of sporadic primary hyperparathyroidism: Results of a case-control study. Surg Endosc 2001:15:1116.

56. Henry JF, Iacobone M, Mirallie E, et al. Indications and results of video-assisted parathyroidectomy by a lateral approach in patients with primary hyperparathyroidism. Surgery 2001:130:999.

57. Agarwal G, Barraclough BH, Robinson BG, et al. Minimally invasive parathyroidectomy using the "focused" lateral approach: I. Results of the first 100 consecutive cases. Aust N Z J Surg 2002;72:100.

58. Worsey MJ, Carty SE, Watson CG. Success of unilateral neck exploration for sporadic primary hyperparathyroidism. Surgery 1993:114:1024.

59. Westerdal J, Lindbom P, Valdemarsson S, et al. Risk factors for postoperative hypocalcemia after surgery for primary hyperparathyroidism. Arch Surg 2000; 135:142.

60. Irvin GL III, Sfakianakis G, Yeung L, et al. Ambulatory parathyroidectomy for primary hyperparathyroidism. Arch Surg 1996; 131:1074.

61. Udelsman R. Six hundred fifty-six consecutive explorations for primary hyperparathyroidism. Ann Surg 2002;235:665.

62. Udelsman R, Donovan PI, Sokoll LJ. One hundred consecutive minimally invasive parathyroid explorations. Ann Surg 2000;232:331.

63. Udelsman R. Is unilateral neck exploration for parathyroid adenoma appropriate? Adv Surg 2000;34:319.

64. Reeve TS, Babidge WJ, Parkyn RF, et al. Minimally invasive surgery for primary hyperparathyroidism: Systematic review. Arch Surg 2000:135:481.

65. Sackett WR, Barraclough B, Reeve TS, Delbridge LW. World-wide trends in the surgical treatment of primary hyperparathyroidism in the era of minimally invasive parathyroidectomy. Arch Surg 2002; 137:1055.

66. Westerdahl J, Lindblom P, Bergenfelz A. Measurement of intraoperative parathyroid hormone predicts long-term operative success. Arch Surg 2002;137:186.

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