Parathyroid autotransplantation: a phase-based framework for surgical decision-making

Parathyroid autotransplantation (PAT), a technique in which parathyroid tissue is excised from its original site and transplanted to an alternative site within the same individual, serves as a pivotal preventive and therapeutic strategy for hypoparathyroidism. Its success is not guaranteed by a single intervention but is determined by a series of crucial decisions that directly influence autograft survival and function, such as the physiological or pathological state of the parathyroid gland, revascularization, and the quality of the surgical process. This review comprehensively delineates the PAT procedure as a continuous, phase-based process, including intraoperative parathyroid identification and evaluation techniques; determining whether to perform PAT and the quantity of autotransplanted tissue; selecting immediate or delayed PAT; processing parathyroid autografts; choosing the PAT site; and methods for evaluating autograft function. By synthesizing the latest evidence for each of these critical phases, this novel, phase-based perspective not only provides a structured framework to guide surgical decision-making but also highlights the research and development potential of PAT, with the ultimate goal of optimizing patient outcomes.