Fewer patients now undergo classic open bilateral neck exploration for PHPT because of the desire for smaller scars, shorter postoperative stay, and less postoperative distress. Better preoperative localization studies now allow for patient selection for targeted parathyroidectomies with low rates of persistent disease.23 Endoscopic parathyroidectomy offers thorough exploration of the neck, unilaterally23 or even bilaterally.1024 The use of qPTHa reduces the possibility of missing a second adenoma or a hyperplasia. In our experience, qPTHa has helped avoid conversion to open surgery in 2% of our patients.

Endoscopic parathyroidectomy is an excellent option. In contrast, radio-guided parathyroidectomy is logistically demanding, requiring nuclear mappings and coordination among the nuclear medicine physician, the operating room staff, and the surgical team.25 Endoscopic parathyroidectomy allows for neck exploration of two glands and, with a central incision, even bilateral exploration of four glands. This is not possible by the lateral approach.


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6. Rubino F, Pamoukian VN, Zhu JF, et al. Endoscopic endocrine neck surgery with carbon dioxide insufflation: The intracranial pressure in a large animal model. Surgery 2000:128:1035.

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10. 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.

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19. Miccoli P, Bendinelli C, Berti P, et al. Video-assisted versus conventional parathyroidectomy in primary hyperparathyroidism: A prospective randomized study. Surgery 1999:126:1117.

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