[Surgical treatment of primary hyperparathyroidism: how high do we place the crossbar?]

Minimally-invasive parathyroidectomy has improved to a level that has made it the operation of first choice in the treatment of primary hyperparathyroidism. A gamma probe should be used when the radio-guided technique is performed and quick intra-operative parathormone testing should be used with all other minimally-invasive techniques. This not only serves as an instrument for quality control but also improves the expertise necessary to consistently obtain good results. Although minimally-invasive parathyroidectomy is now regarded as the preferred procedure, it has not completely replaced conventional neck exploration, which was once the standard operation. When used in combination--minimally-invasive parathyroidectomy when possible and conventional neck exploration when necessary--virtually every patient with primary hyperparathyroidism can look forward to a successful surgical outcome.