Results of Unilateral Parathyroidectomy Original Approach

When patients are considered for unilateral parathyroidectomy, it is important to exclude familial HPT because these patients usually have multiple abnormal parathyroid glands. Patients who had previous operations in their neck for either parathyroid disease or thyroid disease are not candidates for unilateral parathyroidectomy because the functional parathyroid reserve cannot be evaluated.

Identification of a normal parathyroid gland is easy in most instances, but occasionally it is difficult or even impossible. Extensive exploration to identify normal parathyroid glands should be avoided because it might result in ischemia of the normal glands. When original exploratory principles were followed in 102 patients in which the side of the parathyroid neoplasm was unknown preoperatively, the intended operation could be performed in 88 patients (i.e., unilateral parathyroidectomy either with or without bilateral exploration). In 14 patients, various examples of atypical exploration of normal parathyroid glands were applied.11 Most commonly, one or two of the normal glands were missing.11 In a multicenter study, including five departments of surgery, unilateral neck exploration was compared to bilateral neck exploration in regard to long-term effects on the serum calcium level.12 In each department, the prevailing exploratory principles were strictly defined. All patients from a 5-year period fulfilling these definitions and other inclusion criteria were analyzed postoperatively and after 8 to 9 years with regard to calcium status. Two percent of the patients who underwent unilateral operations had hypercalcemia after 8.7 years, whereas 5% of those patients who had a bilateral neck exploration had hypercalcemia after an average follow-up time of 8.0 years. Permanent hypocalcemia occurred in 2% and in 6% of those patients who had a unilateral and bilateral neck exploration, respectively. Normocalcemia was observed in 96% of patients who had unilateral neck exploration. In patients who had bilateral neck exploration, 89% were normocalcemic.12

Also, the frequency of early postoperative hypocalcemia was significantly lower in the patients who had unilateral neck exploration as compared to patients who had bilateral neck exploration. None of the patients who had a unilateral approach had a postoperative serum calcium below 2.00 mmol/L, whereas among patients who had a bilateral approach 19% had serum calcium levels below 2.00 mmol/L.

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