Trends in surgical techniques

SUMMARY At present surgery is the only effective treatment for primary hyperparathyroidism. For many years bilateral cervical exploration has been the preferred surgical approach and has been limited to those patients with symptoms or complications of the disease. Recent improvement in preoperative localization techniques, combined with the feasibility of intraoperative parathyroid hormone measurement, has increased the opportunity to perform minimally invasive or unilateral surgery. There are now several minimally invasive procedures, including unilateral neck exploration, video assisted and complete endoscopic techniques. This review provides an overview of the different surgical approaches currently used for the management of primary hyperparathyroidism and discusses the indications, advantages and disadvantages of each technique.