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Surgical strategy for sporadic primary hyperparathyroidism an evidence-based approach to surgical strategy, patient selection, surgical access, and reoperations

  • Current Concepts in Endocrine Surgery
  • Published:
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Abstract

Purpose

Progress in parathyroid imaging has brought substantial changes in the surgical strategy to approach patients with sporadic primary hyperparathyroidism (pHPT). The present review is focused on the safety and efficacy of limited parathyroid exploration.

Materials and methods

Review of the literature focused on studies dealing with unilateral (two-gland exploration) or selective parathyroidectomy (one-gland exploration) in selected patients with pHPT and on the classification of published reports according to the degree of evidence.

Results

Parathyroid exploration limited to a solitary parathyroid adenoma can be considered a minimally invasive procedure that can be performed by the minicervicotomy, video-assisted, or endoscopic approaches. In properly selected patients, it affords results comparable to those of four-gland bilateral exploration in terms of cure and recurrence. It causes less postoperative hypocalcemia.

Conclusions

Selective parathyroidectomy is an option for patients with positive preoperative localization tests undergoing first-time surgery who have no family history of pHPT, no goiter for which surgical therapy is proposed, and are not on lithium therapy.

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References

  1. Russell CF, Edis AJ (1982) Surgery for primary hyperparathyroidism: experience with 500 consecutive cases and evaluation of the role of surgery in the asymptomatic patient. Br J Surg 69:244–247

    Article  PubMed  CAS  Google Scholar 

  2. Roth SI, Wang CA, Potts JT Jr (1975) The team approach to primary hyperparathyroidism. Hum Pathol 6:645–648

    Article  PubMed  CAS  Google Scholar 

  3. Tibblin S, Bondeson AG, Ljungberg O (1982) Unilateral parathyroidectomy in hyperparathyroidism due to single adenoma. Ann Surg 195:245–252

    Article  PubMed  CAS  Google Scholar 

  4. Tibblin S, Bondeson AG, Bondeson L, Ljungberg O (1984) Surgical strategy in hyperparathyroidism due to solitary adenoma. Ann Surg 200:776–784

    Article  PubMed  CAS  Google Scholar 

  5. Russell CF, Laird JD, Ferguson WR (1990) Scan-directed unilateral cervical exploration for parathyroid adenoma: a legitimate approach? World J Surg 14:406–409

    Article  PubMed  CAS  Google Scholar 

  6. Russell CF, Dolan SJ, Laird JD (2006) Randomized clinical trial comparing scan-directed unilateral versus bilateral cervical exploration for primary hyperparathyroidism due to solitary adenoma. Br J Surg 93:418–421

    Article  PubMed  CAS  Google Scholar 

  7. Vogel LM, Lucas R, Czako P (1998) Unilateral parathyroid exploration. Am Surg 64:693–696 discussion 696–697

    PubMed  CAS  Google Scholar 

  8. Udelsman R (2002) Six hundred fifty-six consecutive explorations for primary hyperparathyroidism. Ann Surg 235:665–670

    Article  PubMed  Google Scholar 

  9. Pellitteri PK (2003) Directed parathyroid exploration: evolution and evaluation of this approach in a single-institution review of 346 patients. Laryngoscope 113:1857–1869

    Article  PubMed  Google Scholar 

  10. Inabnet WB 3rd, Dakin GF, Haber RS, Rubino F, Diamond EJ, Gagner M (2002) Targeted parathyroidectomy in the era of intraoperative parathormone monitoring. World J Surg 26:921–925

    Article  PubMed  Google Scholar 

  11. Mortier PE, Mozzon MM, Fouquet OP, Soudan BC, Huglo DG, Cussac JF, Proye CA (2004) Unilateral surgery for hyperparathyroidism: indications, limits, and late results—new philosophy or expensive selection without improvement of surgical results? World J Surg 28:1298–1304

    Article  PubMed  Google Scholar 

  12. Gurnell EM, Thomas SK, McFarlane I, Munday I, Balan KK, Berman L, Chatterjee VK, Wishart GC (2004) Focused parathyroid surgery with intraoperative parathyroid hormone measurement as a day-case procedure. Br J Surg 91:78–82

    Article  PubMed  CAS  Google Scholar 

  13. Jacobson SR, van Heerden JA, Farley DR, Grant CS, Thompson GB, Mullan BP, Curlee KJ (2004) Focused cervical exploration for primary hyperparathyroidism without intraoperative parathyroid hormone monitoring or use of the gamma probe. World J Surg 28:1127–1131

    Article  PubMed  Google Scholar 

  14. Pang T, Stalberg P, Sidhu S, Sywak M, Wilkinson M, Reeve TS, Delbridge L (2007) Minimally invasive parathyroidectomy using the lateral focused mini-incision technique without intraoperative parathyroid hormone monitoring. Br J Surg 94:315–319

    Article  PubMed  CAS  Google Scholar 

  15. Mihai R, Palazzo FF, Gleeson FV, Sadler GP (2007) Minimally invasive parathyroidectomy without intraoperative parathyroid hormone monitoring in patients with primary hyperparathyroidism. Br J Surg 94:42–47

    Article  PubMed  CAS  Google Scholar 

  16. Baliski CR, Stewart JK, Anderson DW, Wiseman SM, Bugis SP (2005) Selective unilateral parathyroid exploration: an effective treatment for primary hyperparathyroidism. Am J Surg 189:596–600

    Article  PubMed  Google Scholar 

  17. Westerdahl J, Bergenfelz A (2007) Unilateral versus bilateral neck exploration for primary hyperparathyroidism: five-year follow-up of a randomized controlled trial. Ann Surg 246:976–980

    Article  PubMed  Google Scholar 

  18. Bergenfelz A, Lindblom P, Tibblin S, Westerdahl J (2002) Unilateral versus bilateral neck exploration for primary hyperparathyroidism: a prospective randomized controlled trial. Ann Surg 236:543–551

    Article  PubMed  Google Scholar 

  19. Aarum S, Nordenström J, Reihnér E, Zedenius J, Jacobsson H, Danielsson R, Bäckdahl M, Lindholm H, Wallin G, Hamberger B, Farnebo LO (2007) Operation for primary hyperparathyroidism: the new versus the old order. A randomised controlled trial of preoperative localisation. Scand J Surg 96:26–30

    PubMed  CAS  Google Scholar 

  20. Slepavicius A, Beisa V, Janusonis V, Strupas K (2008) Focused versus conventional parathyroidectomy for primary hyperparathyroidism: a prospective, randomized, blinded trial. Langenbecks Arch Surg 393:659–666

    Article  PubMed  Google Scholar 

  21. Sackett WR, Barraclough B, Reeve TS, Delbridge LW (2002) Worldwide trends in the surgical treatment of primary hyperparathyroidism in the era of minimally invasive parathyroidectomy. Arch Surg 137:1055–1059

    Article  PubMed  Google Scholar 

  22. Low RA, Katz AD (1998) Parathyroidectomy via bilateral cervical exploration: a retrospective review of 866 cases. Head Neck 20:583–587

    Article  PubMed  CAS  Google Scholar 

  23. Siperstein A, Berber E, Mackey R, Alghoul M, Wagner K, Milas M (2004) Prospective evaluation of sestamibi scan, ultrasonography, and rapid PTH to predict the success of limited exploration for sporadic primary hyperparathyroidism. Surgery 136:872–880

    Article  PubMed  Google Scholar 

  24. McGill J, Sturgeon C, Kaplan SP, Chiu B, Kaplan EL, Angelos P (2008) How does the operative strategy for primary hyperparathyroidism impact the findings and cure rate? A comparison of 800 parathyroidectomies. J Am Coll Surg 207:246–249

    Article  PubMed  Google Scholar 

  25. Mun HC, Conigrave A, Wilkinson M, Delbridge L (2005) Surgery for hyperparathyroidism: does morphology or function matter most? Surgery 138:1111–1120

    Article  PubMed  Google Scholar 

  26. Kebebew E, Hwang J, Reiff E, Duh QY, Clark OH (2006) Predictors of single-gland vs multigland parathyroid disease in primary hyperparathyroidism: a simple and accurate scoring model. Arch Surg 141:777–782

    Article  PubMed  Google Scholar 

  27. Gawande AA, Monchik JM, Abbruzzese TA, Iannuccilli JD, Ibrahim SI, Moore FD Jr (2006) Reassessment of parathyroid hormone monitoring during parathyroidectomy for primary hyperparathyroidism after 2 preoperative localization studies. Arch Surg 141:381–384

    Article  PubMed  CAS  Google Scholar 

  28. Irvin GL 3rd, Sfakianakis G, Yeung L, Deriso GT, Fishman LM, Molinari AS, Foss JN (1996) Ambulatory parathyroidectomy for primary hyperparathyroidism. Arch Surg 131:1074–1078

    PubMed  Google Scholar 

  29. Norman JG, Politz DE (2007) Safety of immediate discharge after parathyroidectomy: a prospective study of 3,000 consecutive patients. Endocr Pract 13:105–113

    PubMed  Google Scholar 

  30. Mihai R, Weisters M, Stechman MJ, Gleeson F, Sadler GP (2008) Cost-effectiveness of scan-directed parathyroidectomy. Langenbecks Arch Surg 393:739–743

    Article  PubMed  Google Scholar 

  31. Burkey SH, Van Heerden JA, Farley DR, Thompson GB, Grant CS, Curlee KJ (2002) Will directed parathyroidectomy utilizing the gamma probe or intraoperative parathyroid hormone assay replace bilateral cervical exploration as the preferred operation for primary hyperparathyroidism? World J Surg 26:914–920

    Article  PubMed  Google Scholar 

  32. Goldstein RE, Carter WM 2nd, Fleming M, Bumpous J, Lentsch E, Rice M, Flynn M (2006) Unilateral cervical surgical exploration aided by intraoperative parathyroid hormone monitoring in patients with primary hyperparathyroidism and equivocal sestamibi scan results. Arch Surg 141:552–559

    Article  PubMed  Google Scholar 

  33. Chan RK, Ruan DT, Gawande AA, Moore FD Jr (2008) Surgery for hyperparathyroidism in image-negative patients. Arch Surg 143:335–337

    Article  PubMed  Google Scholar 

  34. Miccoli P, Berti P, Materazzi G, Massi M, Picone A, Minuto MN (2004) Results of video-assisted parathyroidectomy: single institution's six-year experience. World J Surg 28:1216–1218

    Article  PubMed  Google Scholar 

  35. Gagner M, Rubino F (2004) Endoscopic parathyroidectomy. In: Schwartz AE, Pertsemlidis D, Gagner M (eds) Endocrine surgery. Marcel Dekker, New York, pp 289–296

    Google Scholar 

  36. Henry JF, Sebag F, Tamagnini P, Forman C, Silaghi H (2004) Endoscopic parathyroid surgery: results of 356 consecutive procedures. World J Surg 28:1219–1223

    Article  PubMed  Google Scholar 

  37. Grant SC, Thompson G, Farley D, van Heerden J (2005) Primary hyperparathyroidism surgical management since introduction of minimally invasive parathyroidectomy. Mayo Clinic experience. Arch Surg 140:472–478

    Article  PubMed  Google Scholar 

  38. Barczynski M, Cichon S, Konturek A, Cichon W (2006) Minimally invasive video-assisted parathyroidectomy vs. open minimally invasive parathyroidectomy for a solitary parathyroid adenoma: a prospective, randomized, blinded trial. World J Surg 30:721–731

    Article  PubMed  Google Scholar 

  39. Lo CY, Chan WF, Luk JM (2003) Minimally invasive endoscopic-assisted parathyroidectomy for primary hyperparathyroidism. Surg Endosc 17:1932–1936

    Article  PubMed  Google Scholar 

  40. Ng WT (2004) Letter 2: Focused parathyroid surgery with intraoperative parathyroid hormone measurement as a day-case procedure (Br J Surg 2004; 91:78–82). Br J Surg 91:898

    Article  PubMed  CAS  Google Scholar 

  41. Soon PS, Yeh MW, Sywak MS, Roach P, Delbridge LW, Sidhu SB (2007) Minimally invasive parahyroidectomy using the lateral focused mini-incision approach: is there a learning curve for surgeons experienced in the open procedure? J Am Coll Surg 204:91–95

    Article  PubMed  Google Scholar 

  42. Henry JF, Sebag F, Cherenko M, Ippolito G, Taieb D, Vaillant J (2008) Endoscopic parayhyroidectomy: why and when? World J Surg 32:2509–2515

    Article  PubMed  Google Scholar 

  43. Sitges-Serra A, Prieto R, Membrilla E, Sancho JJ (2008) Surgery for sporadic primary hyperparathyroidism: controversies and evidence-based approach. Langenbecks Arch Surg 393:239–244

    Article  PubMed  Google Scholar 

  44. Miccoli P, Barellini L, Monchik JM, Rago R, Berti PF (2005) Randomized clinical trial comparing regional and general anaesthesia in minimally invasive video-assisted parathyroidectomy. Br J Surg 92:814–818

    Article  PubMed  CAS  Google Scholar 

  45. Cohen MS, Finkelstein SE, Brunt LM, Haberfeld E, Kangrga I, Moley JF, Lairmore TC (2005) Outpatient minimally invasive parathyroidectomy using local/regional anesthesia: a safe and effective operative approach for selected patients. Surgery 138:681–689

    Article  PubMed  Google Scholar 

  46. Carling T, Donovan P, Rinder C, Udelsman R (2006) Minimally invasive parathyroidectomy using cervical block. Reasons for conversion to general surgery. Arch Surg 141:401–404

    Article  PubMed  Google Scholar 

  47. Pintaric TS, Hocevar M, Jereb S, Casati A, Jankovic VN (2007) A prospective, randomized comparison between combined (deep and superficial) and superficial cervical plexus block with levobupivacaine for minimally invasive parathyroidectomy. Anesth Analg 105:1160–1163

    Article  PubMed  CAS  Google Scholar 

  48. Black MJ, Ruscher AE, Lederman J, Chen H (2006) Local/cervical block anaesthesia versus general anaesthesia for minimally invasive parathyroidectomy: What are the advantages? Ann Surg Oncol 14:744–749

    Article  PubMed  Google Scholar 

  49. Lo Gerfo P (1999) Bilateral neck exploration for parathyroidectomy under local anaesthesia: a viable technique for patients with coexisting thyroid disease with or without sestamibi scanning. Surgery 126:1011–1014

    Article  PubMed  CAS  Google Scholar 

  50. Shindo ML, Rosenthal JM, Lee T (2008) Minimally invasive parathyroidectomy using local anaesthesia with intravenous sedation and targeted approaches. Otolaryngol Head Neck Surg 138:381–387

    Article  PubMed  Google Scholar 

  51. Murphy C, Norman J (1999) The 20% rule: a simple, instantaneous radioactivity measurement defines cure and allows elimination of frozen sections and hormone assays during parathyroidectomy. Surgery 126:1023–1028

    Article  PubMed  CAS  Google Scholar 

  52. Bonjer HJ, Bruining HA, Pols HA, de Herder WW, Proye CA, Carnaille BM, Mohamedammin DS, Steyerberg EW, Breeman WA, Krening EP (1998) 2-Methoxyisobutylisonitrile probe during parathyroid surgery: tool or gadget? World J Surg 22:507–511

    Article  PubMed  CAS  Google Scholar 

  53. Dackiw AP, Sussman JJ, Fritsche HA Jr, Delpassand ES, Stanford P, Hoff A (2000) Relative contributions of technetium Tc 99m sestamibi scintigraphy, intraoperative gamma probe detection, and the rapid parathyroid hormone assay to the surgical management of hyperparathyroidism. Arch Surg 135:550–555

    Article  PubMed  CAS  Google Scholar 

  54. Inabnet WB 3rd, Kim CK, Haber RS, Lopchinsky RA (2002) Radioguidance is not necessary during parathyroidectomy. Arch Surg 137:967–970

    Article  PubMed  Google Scholar 

  55. Sosa JA, Powe NR, Levine MA, Udelsman R, Zeiger MA (1998) Profile of a clinical practice: thresholds for surgery and surgical outcomes for patients with primary hyperparathyroidism: a national survey of endocrine surgeons. J Clin Endocrinol Metab 83:2658–2665

    Article  PubMed  CAS  Google Scholar 

  56. Bruining HA, Birkenhäger JC, Ong GL, Lamberts SW (1987) Causes of failure in operations for hyperparathyroidism. Surgery 101:562–565

    PubMed  CAS  Google Scholar 

  57. Mundschenk J, Klose S, Lorenz K, Dralle H, Lehnert H (1999) Diagnostic strategies and surgical procedures in persistent or recurrent primary hyperparathyroidism. Exp Clin Endocrinol Diabetes 107:331–336

    Article  PubMed  CAS  Google Scholar 

  58. Mariette C, Pellissier L, Combemale F, Quievreux JL, Carnaille B, Proye C (1998) Reoperation for persistent or recurrent primary hyperparathyroidism. Langenbecks Arch Surg 383:174–179

    PubMed  CAS  Google Scholar 

  59. Wells SA Jr, Debenedetti MK, Doherty GM (2002) Recurrent or persistent hyperparathyroidism. J Bone Miner Res 17(S2):158–162

    Google Scholar 

  60. Tezelman S, Shen W, Siperstein AE, Duh QY, Clark OH (1995) Persistent or recurrent hyperparathyroidism in patients with double adenomas. Surgery 118:1115–1122

    Article  PubMed  CAS  Google Scholar 

  61. Irvin GL 3rd, Molinari AS, Figueroa C, Carneiro DM (1999) Improved success rate in reoperative parathyroidectomy with intraoperative PTH assay. Ann Surg 229:874–878

    Article  PubMed  Google Scholar 

  62. Arnalsteen L, Quievreux JL, Huglo D, Pattou F, Carnaille B, Proye C (2004) Reoperation for persistent or recurrent primary hyperparathyroidism. Seventy-seven cases among 1888 operated patients. Ann Chir 129:224–231

    Article  PubMed  CAS  Google Scholar 

  63. Thompson GB, Grant CS, Perrier ND et al (1999) Reoperative parathyroid surgery in the era of sestamibi scanning and intraoperative parathyroid hormone monitoring. Arch Surg 134:699–704

    Article  PubMed  CAS  Google Scholar 

  64. Shen W, Düren M, Morita E et al (1996) Reoperation for persistent or recurrent primary hyperparathyroidism. Arch Surg 131:861–867

    PubMed  CAS  Google Scholar 

  65. Hasse C, Sitter H, Brune M, Wollenteit I, Nies C, Rothmund M (2002) Quality of life and patient satisfaction after reoperation for primary hyperparathyroidism: analysis of long-term results. World J Surg 26:1029–1036

    Article  PubMed  Google Scholar 

  66. Sebag F, Hubbard JG, Maweja S, Misso C, Tardivet L, Henry JF (2003) Negative preoperative localization studies are highly predictive of multiglandular disease in sporadic primary hyperparathyroidism. Surgery 134:1038–1041

    Article  PubMed  Google Scholar 

  67. Caron NR, Sturgeon C, Clark OH (2004) Persistent and recurrent hyperparathyroidism. Curr Treat Options Oncol 5:335–345

    Article  PubMed  Google Scholar 

  68. Grant CS, van Heerden JA, Charboneau JW, James EM, Reading CC (1986) Clinical management of persistent and/or recurrent primary hyperparathyroidism. World J Surg 10:555–565

    Article  PubMed  CAS  Google Scholar 

  69. Udelsman R, Donovan PI (2006) Remedial parathyroid surgery: changing trends in 130 consecutive cases. Ann Surg 244:471–479

    PubMed  Google Scholar 

  70. Alexander HR Jr, Chen CC, Shawker T et al (2002) Role of preoperative localization and intraoperative localization maneuvers including intraoperative PTH assay determination for patients with persistent or recurrent hyperparathyroidism. J Bone Miner Res 17(S2):133–140

    Google Scholar 

  71. Jaskowiak N, Norton JA, Alexander HR et al (1996) A prospective trial evaluating a standard approach to reoperation for missed parathyroid adenoma. Ann Surg 224:308–320

    Article  PubMed  CAS  Google Scholar 

  72. Kraimps JL, Margerit D, Barbier J (1995) Management of primary hyperparathyroidism in case of negative cervicotomy. Ann Chir 49:138–142

    PubMed  CAS  Google Scholar 

  73. Rodríguez JM, Tezelman S, Siperstein AE et al (1994) Localization procedures in patients with persistent or recurrent hyperparathyroidism. Arch Surg 129:870–875

    Google Scholar 

  74. Simeone DM, Sandelin K, Thompson NW (1995) Undescended superior parathyroid gland: a potential cause of failed cervical exploration for hyperparathyroidism. Surgery 118:949–956

    Article  PubMed  CAS  Google Scholar 

  75. Gough I (2006) Reoperative parathyroid surgery: the importance of ectopic location and multigland disease. ANZ J Surg 76:1048–1050

    Article  PubMed  Google Scholar 

  76. Gauger PG, Agarwal G, England BG et al (2001) Intraoperative parathyroid hormone monitoring fails to detect double parathyroid adenomas: a 2-institution experience. Surgery 130:1005–1010

    Article  PubMed  CAS  Google Scholar 

  77. Haciyanli M, Lal G, Morita E, Duh QY, Kebebew E, Clark OH (2003) Accuracy of preoperative localization studies and intraoperative parathyroid hormone assay in patients with primary hyperparathyroidism and double adenoma. J Am Coll Surg 197:739–746

    Article  PubMed  Google Scholar 

  78. Carty SE, Norton JA (1991) Management of patients with persistent or recurrent primary hyperparathyroidism. World J Surg 15:716–723

    Article  PubMed  CAS  Google Scholar 

  79. Henry JF, Defechereux T, Raffaelli M, Lubrano D, Iacobone M (2000) Supernumerary ectopic hyperfunctioning parathyroid gland: a potential pitfall in surgery for sporadic primary hyperthyroidism. Ann Chir 125:247–252

    Article  PubMed  CAS  Google Scholar 

  80. Fraker DL, Travis WD, Merendino JJ et al (1991) Locally recurrent parathyroid neoplasms as a cause for recurrent and persistent primary hyperparathyroidism. Ann Surg 213:58–65

    Article  PubMed  CAS  Google Scholar 

  81. Harman CR, Grant CS, Hay ID et al (1998) Indications, technique, and efficacy of alcohol injection of enlarged parathyroid glands in patients with primary hyperparathyroidism. Surgery 124:1011–1019

    Article  PubMed  CAS  Google Scholar 

  82. Hessman O, Stålberg P, Sundin A et al (2008) High success rate of parathyroid reoperation may be achieved with improved localization diagnosis. World J Surg 32:774–781

    Article  PubMed  Google Scholar 

  83. Hellman P, Skogseid B, Oberg K, Juhlin C, Akerström G, Rastad J (1998) Primary and reoperative parathyroid operations in hyperparathyroidism of multiple endocrine neoplasia type 1. Surgery 124:993–999

    PubMed  CAS  Google Scholar 

  84. Jones JJ, Brunaud L, Dowd CF, Duh QY, Morita E, Clark OH (2002) Accuracy of selective venous sampling for intact parathyroid hormone in difficult patients with recurrent or persistent hyperparathyroidism. Surgery 132:944–950

    Article  PubMed  Google Scholar 

  85. Rotstein L, Irish J, Gullane P, Keller MA, Sniderman K (1998) Reoperative parathyroidectomy in the era of localization technology. Head Neck 20:535–539

    Article  PubMed  CAS  Google Scholar 

  86. Gotway MB, Reddy GP, Webb WR, Morita ET, Clark OH, Higgins CB (2001) Comparison between MR imaging and 99mTc MIBI scintigraphy in the evaluation of recurrent of persistent hyperparathyroidism. Radiology 218:783–790

    PubMed  CAS  Google Scholar 

  87. Freudenberg LS, Frilling A, Sheu SY, Görges R (2006) Optimizing preoperative imaging in primary hyperparathyroidism. Langenbecks Arch Surg 391:551–556

    Article  PubMed  Google Scholar 

  88. Fahy BN, Bold RJ, Beckett L, Schneider PD (2002) Modern parathyroid surgery: a cost-benefit analysis of localizing strategies. Arch Surg 137:917–922

    Article  PubMed  Google Scholar 

  89. Feingold DL, Alexander HR, Chen CC et al (2000) Ultrasound and sestamibi scan as the only preoperative imaging tests in reoperation for parathyroid adenomas. Surgery 128:1103–1109

    Article  PubMed  CAS  Google Scholar 

  90. Reidel MA, Schilling T, Graf S et al (2006) Localization of hyperfunctioning parathyroid glands by selective venous sampling in reoperation for primary or secondary hyperparathyroidism. Surgery 140:907–913

    Article  PubMed  Google Scholar 

  91. Udelsman R, Aruny JE, Donovan PI et al (2003) Rapid parathyroid hormone analysis during venous localization. Ann Surg 237:714–719

    Article  PubMed  Google Scholar 

  92. Maser C, Donovan P, Santos F et al (2006) Sonographically guided fine needle aspiration with rapid parathyroid hormone assay. Ann Surg Oncol 13:1690–1695

    Article  PubMed  Google Scholar 

  93. Norman J, Denham D (1998) Minimally invasive radioguided parathyroidectomy in the reoperative neck. Surgery 124:1088–1092

    Article  PubMed  CAS  Google Scholar 

  94. Ros S, Sitges-Serra A, Pereira JA et al (2008) Intrathyroid parathyroid adenomas: right and low. Cir Esp 84:196–200

    Article  PubMed  Google Scholar 

  95. Ravipati NB, McLemore EC, Schlinkert RT, Argueta R (2008) Anterior mediastinotomy for parathyroidectomy. Am J Surg 195:799–802

    Article  PubMed  Google Scholar 

  96. Alesina PF, Moka D, Mahlstedt J, Walz MK (2008) Thoracoscopic removal of mediastinal hyperfunctioning parathyroid glands: personal experience and review of the literature. World J Surg 32:224–231

    Article  PubMed  CAS  Google Scholar 

  97. Cupisti K, Dotzenrath C, Simon D, Röher HD, Goretzki PE (2002) Therapy of suspected intrathoracic parathyroid adenomas. Experiences using open transthoracic approach and video-assisted thoracoscopic surgery. Langenbecks Arch Surg 386:488–493

    Article  PubMed  Google Scholar 

  98. Medrano C, Hazelrigg SR, Landreneau RJ, Boley TM, Shawgo T, Grasch A (2000) Thoracoscopic resection of ectopic parathyroid glands. Ann Thorac Surg 69:221–223

    Article  PubMed  CAS  Google Scholar 

  99. Iacobone M, Ruffolo C, Lumachi F, Favia G (2005) Results of iterative surgery for persistent and recurrent parathyroid carcinoma. Langenbecks Arch Surg 390:385–390

    Article  PubMed  Google Scholar 

  100. Kebebew E, Arici C, Duh QY, Clark OH (2001) Localization and reoperation results for persistent and recurrent parathyroid carcinoma. Arch Surg 136:878–885

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. John Radcliffe Hospital, Oxford, UK

    Radu Mihai

  2. University of Krakow, Krakow, Poland

    Marcin Barczynski

  3. University of Padua, Padova, Italy

    Maurizio Iacobone

  4. Department of Surgery, Hospital del Mar, Paseo Marítimo 25–29, 08003, Barcelona, Spain

    Antonio Sitges-Serra

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  1. Radu Mihai
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  4. Antonio Sitges-Serra
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Mihai, R., Barczynski, M., Iacobone, M. et al. Surgical strategy for sporadic primary hyperparathyroidism an evidence-based approach to surgical strategy, patient selection, surgical access, and reoperations. Langenbecks Arch Surg 394, 785–798 (2009). https://doi.org/10.1007/s00423-009-0529-1

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