Focused versus conventional parathyroidectomy for primary hyperparathyroidism: a prospective, randomized, blinded...

Area of Science:

• Endocrinology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Bilateral neck exploration (BNE) was the traditional standard for primary hyperparathyroidism (pPHP).
• Advances in localization and intraoperative monitoring have enabled minimally invasive approaches.
• This study compares BNE with focused parathyroidectomy (FP).

Purpose of the Study:

• To compare the efficacy and outcomes of BNE versus FP for primary hyperparathyroidism.
• To evaluate postoperative pain, cosmetic satisfaction, and quality of life.
• To assess the cost-effectiveness of each surgical approach.

Main Methods:

• A prospective, randomized, blind trial involving 48 patients with pPHP.
• Patients were randomized to either BNE (23 patients) or FP (24 patients).
• FP utilized preoperative localization and intraoperative intact parathyroid hormone (IIPTH) monitoring; BNE did not.

Main Results:

• All patients achieved cure after the primary operation; operative times were similar.
• FP group showed significantly lower postoperative pain, analgesic use, and shorter scar length.
• FP resulted in higher short-term cosmetic satisfaction, though long-term significance diminished; FP was more expensive.

Conclusions:

• Both BNE and FP are safe and effective for pPHP treatment.
• FP offers advantages including reduced postoperative pain, analgesic requirements, and improved short-term cosmetic results.
• While FP is more costly, its benefits in patient recovery and satisfaction warrant consideration.