Impact of sonography on surgery for primary hyperparathyroidism

The impact of preoperative sonographic localization of enlarged parathyroid glands was evaluated from the standpoint of operative time and complication rates. There was a reduction in the average time from 135 minutes when findings were false-negative to 111 minutes when findings were positive. The rate of complication was not changed by accurate preoperative localization. When the operative goal is to find all parathyroid glands in every patient, the value of preoperative localization of parathyroid tumors by any current method is slight. Should operative policy favor a search for only one enlarged and one normal gland, or should methods improve to the point that even normal parathyroid glands can be located reliably, noninvasive localization should prove to be useful, safe, and cost-effective, even when it is carried out before initial operation.