Skip to main content
SpringerLink
Log in

Unilateral Neck Exploration for Primary Hyperparathyroidism

  • Chapter
  • First Online:
Medical and Surgical Treatment of Parathyroid Diseases

  • 986 Accesses

Abstract

Conventional parathyroid surgery requires a large transverse cervical incision and bilateral neck exploration (BNE) with exposure of all four glands. While highly successful, this procedure results in a long scar, and the extensive dissection occasionally risks significant postoperative hypocalcemia. Though some conditions still require bilateral surgery, the majority of patients with primary hyperparathyroidism (PHPT) have a single hyperfunctional gland. Increased understanding of this pathophysiology, along with advances in preoperative imaging modalities and intraoperative adjuncts, have led to the development and successful implementation of minimally invasive, unilateral neck exploration (UNE). This approach improves the cosmetic and physiologic outcomes of parathyroidectomy without compromising the cure rate achieved by conventional surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Barczyński M, Gołkowski F, Nawrot I. The current status of intraoperative iPTH assay in surgery for primary hyperparathyroidism. Gland Surg. 2015;4(1):36–43. Clinical Review; Level 3; Grade A.

    PubMed  PubMed Central  Google Scholar 

  2. Lorenz K, Nguyen-Thanh P, Dralle H. Unilateral open and minimally invasive procedures for primary hyperparathyroidism: a review of selective approaches. Langenbecks Arch Surg. 2000;385(2):106–17. Clinical Review; Level 3; Grade A.

    Article  CAS  PubMed  Google Scholar 

  3. Ritter HE, Milas M. Bilateral parathyroid exploration for hyperparathyroidism. Operat Tech Otolaryngol. 2009;20:44–53. Clinical Review; Level 3; Grade A.

    Article  Google Scholar 

  4. Alhefdhi A, Schneider DF, Sippel R, Chen H. Recurrent and persistence primary hyperparathyroidism occurs more frequently in patients with double adenomas. J Surg Res. 2014;190(1):198–202. Population Study; Level 4.

    Article  CAS  PubMed  Google Scholar 

  5. Karakas E, Schneider R, Rothmund M, et al. Initial surgery for benign primary hyperparathyroidism: an analysis of 1,300 patients in a teaching hospital. World J Surg. 2014;38(8):2011–8. Population Study; Level 4.

    Article  PubMed  Google Scholar 

  6. Bergenfelz A, Lindblom P, Tibblin S, Westerdahl J. Unilateral versus bilateral neck exploration for primary hyperparathyroidism: a prospective randomized controlled trial. Ann Surg. 2002;236(5):543–51. Clinical Investigation; Level 1; Grade B.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Bilezikian JP, Potts Jr JT, Fuleihan GH, et al. Summary statement from a workshop on asymptomatic primary hyperparathyroidism: a perspective for the 21st century. J Clin Endocrinol Metab. 2002;87(12):5353–61. Clinical Review; Level 5.

    Article  CAS  PubMed  Google Scholar 

  8. James BC, Kaplan EL, Grogan RH, Angelos P. What’s in a name?: Providing clarity in the definition of minimally invasive parathyroidectomy. World J Surg. 2015;39(4):975–80. Clinical Review; Level 5.

    Article  PubMed  Google Scholar 

  9. Baliski CR, Stewart JK, Anderson DW, et al. Selective unilateral parathyroid exploration: an effective treatment for primary hyperparathyroidism. Am J Surg. 2005;189(5):596–600. Population Study; Level 2; Grade B.

    Article  PubMed  Google Scholar 

  10. Rajaei MH, Oltmann SC, Adkisson CD, et al. Is intraoperative parathyroid hormone monitoring necessary with ipsilateral parathyroid gland visualization during anticipated unilateral exploration for primary hyperparathyroidism: a two-institution analysis of more than 2,000 patients. Surgery. 2014;156(4):760–6. Population Study; Level 4.

    Article  PubMed  Google Scholar 

  11. Brunaud L, Zarnegar R, Wada N, et al. Incision length for standard thyroidectomy and parathyroidectomy: when is it minimally invasive? Arch Surg. 2003;138(10):1140–3. Population Study; Level 4.

    Article  PubMed  Google Scholar 

  12. Miccoli P, Berti P. Minimally invasive parathyroid surgery. Best Pract Res Clin Endocrinol Metab. 2001;15(2):139–47. Clinical Review; Level 3; Grade A.

    Article  CAS  PubMed  Google Scholar 

  13. Gracie D, Hussain SS. Use of minimally invasive parathyroidectomy techniques in sporadic primary hyperparathyroidism: systematic review. J Laryngol Otol. 2012;126(3):221–7. Clinical Review; Level 1; Grade A.

    Article  CAS  PubMed  Google Scholar 

  14. Cho NL, Gawande AA, Sheu EG, et al. Critical role of identification of the second gland during unilateral parathyroid surgery: a prospective review of 119 patients with concordant localization. Arch Surg. 2011;146(5):512–6. Population Study; Level 4.

    Article  PubMed  Google Scholar 

  15. Mortier PE, Mozzon MM, Fouquet OP, et al. Unilateral surgery for hyperparathyroidism: indications, limits, and late results--new philosophy or expensive selection without improvement of surgical results? World J Surg. 2004;28(12):1298–304. Population Study; Level 4.

    Article  PubMed  Google Scholar 

  16. Bilezikian JP, Brandi ML, Eastell R, et al. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. J Clin Endocrinol Metab. 2014;99(10):3561–9. Clinical Review; Level 5.

    Article  CAS  PubMed  Google Scholar 

  17. Mohebati A, Shaha AR. Imaging techniques in parathyroid surgery for primary hyperparathyroidism. Am J Otol. 2012;33:457–68. Clinical Review; Level 3; Grade A.

    Article  Google Scholar 

  18. Lee JA, Inabnet 3rd WB. The surgeon’s armamentarium to the surgical treatment of primary hyperparathyroidism. J Surg Oncol. 2005;89(3):130–5. Clinical Review; Level 3; Grade A.

    Article  PubMed  Google Scholar 

  19. Singer MC, Pucar D, Mathew M, Terris DJ. Improved localization of sestamibi imaging at high-volume centers. Laryngoscope. 2013;123(1):298–301. Population Study; Level 4.

    Article  PubMed  Google Scholar 

  20. Lew JI, Solorzano CC, Montano RE, et al. Role of intraoperative parathormone monitoring during parathyroidectomy in patients with discordant localization studies. Surgery. 2008;144(2):299–306. Population Study; Level 4.

    Article  PubMed  Google Scholar 

  21. Norlén O, Sidhu S, Sywak M, Delbridge L. Long-term outcome after parathyroidectomy for lithium-induced hyperparathyroidism. Br J Surg. 2014;101(10):1252–6. Population Study; Level 4.

    Article  PubMed  Google Scholar 

  22. Duke WS, Bush CM, Singer MC, et al. Incision planning in thyroid compartment surgery: getting it perfect. Endocr Pract. 2015;21(2):107–14. Population Study; Level 4.

    Article  PubMed  Google Scholar 

  23. Sosa JA, Udelsman R. Minimally invasive parathyroidectomy. Surg Oncol. 2003;12(2):125–34. Clinical Review; Level 3; Grade A.

    Article  PubMed  Google Scholar 

  24. Norman J, Politz D. Prospective study in 3,000 consecutive parathyroid operations demonstrates 18 objective factors that influence the decision for unilateral versus bilateral surgical approach. J Am Coll Surg. 2010;211(2):244–9. Population Study; Level 4.

    Article  PubMed  Google Scholar 

  25. Kell MR, Sweeney KJ, Moran CJ, et al. Minimally invasive parathyroidectomy with operative ultrasound localization of the adenoma. Surg Endosc. 2004;18(7):1097–8. Population Study; Level 4.

    Article  CAS  PubMed  Google Scholar 

  26. Moreno MA, Callender GG, Woodburn K, et al. Common locations of parathyroid adenomas. Ann Surg Oncol. 2011;18(4):1047–51. Population Study; Level 4.

    Article  PubMed  Google Scholar 

  27. Fancy T, Gallagher 3rd D, Hornig JD. Surgical anatomy of the thyroid and parathyroid glands. Otolaryngol Clin North Am. 2010;43(2):221–7. Clinical Review; Level 3; Grade A.

    Article  PubMed  Google Scholar 

  28. Pellitteri PK. Intraoperative assessment of parathyroid hormone. Operat Tech Otolaryngol. 2009;20:60–5. Clinical Review; Level 3; Grade A.

    Article  Google Scholar 

  29. Terris DJ. Novel maneuvers in modern thyroid surgery. Operat Tech Otolaryngol. 2009;20:23–8. Clinical Review; Level 5.

    Article  Google Scholar 

  30. Ahluwalia S, Hannan SA, Mehrzad H, et al. A randomised controlled trial of routine suction drainage after elective thyroid and parathyroid surgery with ultrasound evaluation of fluid collection. Clin Otolaryngol. 2007;32(1):28–31. Clinical Investigation; Level 1; Grade B.

    Article  CAS  PubMed  Google Scholar 

  31. Pothier DD. The use of drains following thyroid and parathyroid surgery: a meta-analysis. J Laryngol Otol. 2005;119(9):669–71. Clinical Review; Level 3; Grade A.

    Article  PubMed  Google Scholar 

  32. Vasher M, Goodman A, Politz D, Norman J. Postoperative calcium requirements in 6,000 patients undergoing outpatient parathyroidectomy: easily avoiding symptomatic hypocalcemia. J Am Coll Surg. 2010;211(1):49–54. Population Study; Level 4.

    Article  PubMed  Google Scholar 

  33. Singer MC, Bhakta D, Seybt MW, Terris DJ. Calcium management after thyroidectomy: a simple and cost-effective method. Otolaryngol Head Neck Surg. 2012;146(3):362–5. Population Study; Level 4.

    Article  PubMed  Google Scholar 

  34. Westerdahl J, Bergenfelz A. Unilateral versus bilateral neck exploration for primary hyperparathyroidism: five-year follow-up of a randomized controlled trial. Ann Surg. 2007;246(6):976–80. Clinical Investigation; Level 1; Grade B.

    Article  PubMed  Google Scholar 

  35. Terris DJ, Weinberger PM, Farrag T, et al. Restoring point-of-care testing during parathyroidectomy with a newer parathyroid hormone assay. Otolaryngol Head Neck Surg. 2011;145(4):557–60. Population Study; Level 2; Grade B.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Otolaryngology, Head and Neck Surgery, Multicare Health System, Tacoma, WA, USA

    William S. Duke M.D.

Authors
  1. William S. Duke M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to William S. Duke M.D. .

Editor information

Editors and Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA

    Brendan C. Stack, Jr.

  2. Department of Geniatrics and Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA

    Donald L. Bodenner

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Duke, W.S. (2017). Unilateral Neck Exploration for Primary Hyperparathyroidism. In: Stack, Jr., B., Bodenner, D. (eds) Medical and Surgical Treatment of Parathyroid Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-26794-4_19

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-26794-4_19

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-26792-0

  • Online ISBN: 978-3-319-26794-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation