[Unilateral parathyroidectomy--a new surgical strategy in hyperparathyroidism due to solitary adenoma]

Unilateral parathyroidectomy (UPTX) was applied as surgical principle for parathyroid adenoma 102 consecutive patients. Intraoperative oil-red-O staining was used for distinction between autonomous and suppressed chief cells. UPTX without contralateral exploration was achieved in 43 patients. In 45 patients two microscopically normal parathyroids were found at the first side and UPTX was performed contralaterally where the adenoma was located. In 14 patients non-UPTX was performed. If more than one, macroscopically, normal parathyroid was found one was removed for histopathology. The intended gland identification was achieved in 93-97%. Supernumerary glands were found in seven patients. Postoperative hypocalcemia was more pronounced after "atypical" operations than UPTX following bilateral exploration. All patients were followed up at least one year. None has developed hypercalcemia. Vitamin D-requiring hypocalcemia is present in two "atypically" operated patients. Removal of one, macroscopically, normal gland, preferably from the adenoma side is advocated. If UPTX can be performed at the first side explored, the contralateral need no exploration.