Parathyroid surgery: we still need traditional and selective approaches

Area of Science:

• Endocrinology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• The traditional bilateral cervical approach has been the gold standard for parathyroidectomy since 1925.
• This method boasts a success rate exceeding 95% for primary hyperparathyroidism treatment.

Purpose of the Study:

• To review the evolution and application of minimally invasive parathyroidectomy techniques.
• To assess the safety and efficacy of novel approaches compared to the traditional method.

Main Methods:

• Review of minimally invasive techniques: focused, radio-guided, video-assisted, and videoscopic parathyroidectomy.
• Emphasis on advancements in pre-operative localization and intraoperative parathyroid hormone (PTH) assays.

Main Results:

• Minimally invasive approaches are safe and effective for solitary parathyroid adenomas.
• These techniques are enabled by improved localization studies and intraoperative PTH monitoring.

Conclusions:

• Minimally invasive parathyroidectomy is a viable option for specific patient groups.
• The traditional bilateral approach remains the standard of care for multiple gland disease or equivocal localization.