Primary surgery for hyperparathyroidism: the lateral approach after preoperative ultrasonographic localization

Increasing experience and improving equipment has made ultrasonography the localizing test of choice before neck exploration for hyperparathyroidism is carried out. A study of 16 patients who were examined with ultrasonography before exploration showed that the sensitivity for finding enlarged parathyroid glands was 80 percent, the specificity 95 percent, and the diagnostic accuracy 91 percent. Our operative technique was altered from the classic midline exploration, with bilateral division of the strap muscles, to a lateral approach on the basis of our experience with a high-risk patient who had undergone unilateral exploration under local anesthesia after successful ultrasonographic localization. We found the results with the lateral approach to be equivalent to the results using the midline approach. The lateral approach appeared to be more direct, efficient, and less traumatic than the classic midline approach. This technique is well suited for parathyroid exploration with local anesthesia in high-risk patients who have multiple system failure.