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Unilateral versus bilateral neck exploration for primary hyperparathyroidism: a prospective randomized controlled
Anders Bergenfelz1, Pia Lindblom, Sten Tibblin
1Department of Surgery, Lund University Hospital, Lund, Sweden. anders.bergenfelz@skane.se
Annals of Surgery
|November 1, 2002
Summary
Unilateral neck exploration for primary hyperparathyroidism leads to fewer hypocalcemia symptoms and shorter surgery times compared to bilateral exploration. This approach is a valid and advantageous surgical strategy, particularly for solitary parathyroid adenomas.
Area of Science:
- Endocrinology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Bilateral neck exploration has been the standard for primary hyperparathyroidism surgery.
- Minimally invasive techniques challenge this standard, aiming to reduce operating time and morbidity.
- No prior prospective randomized trials have directly compared unilateral and bilateral neck exploration in an open setting.
Purpose of the Study:
- To prospectively compare unilateral versus bilateral neck exploration for primary hyperparathyroidism.
- To evaluate surgical outcomes, including operating time and postoperative complications.
Main Methods:
- Ninety-one patients with primary hyperparathyroidism were randomized to unilateral or bilateral neck exploration.
- Unilateral exploration utilized preoperative scintigraphy and intraoperative parathyroid hormone (PTH) monitoring.
- Bilateral exploration relied on gross morphology and frozen section analysis for resection extent.
Main Results:
- Cure rates were high (97%) and similar between groups.
- The unilateral group experienced less postoperative oral calcium consumption and fewer severe symptomatic hypocalcemic events.
- Unilateral exploration resulted in shorter operative times for patients with solitary parathyroid adenomas.
Conclusions:
- Unilateral neck exploration with intraoperative PTH assessment is a safe and effective surgical strategy for primary hyperparathyroidism.
- This approach offers advantages, including reduced early postoperative hypocalcemia, especially for patients with solitary adenomas.