BILATERAL
NECK EXPLORATION IN SPORADIC PRIMARY HYPERPARATHYROIDISM (sPHPT)
sPHPT is
most commonly due to the presence of parathyroid adenoma (solitary [85 %] or
double [5 %]). However, in a significant percentage of patients (up to 15 %)
sPHPT may be caused by diffuse hyperplasia of parathyroid glands. Bilateral
neck exploration (BNE) has been the procedure of choice in the past, allowing
the identification of all four parathyroid glands and resection of the diseased
gland(-s). More than 35 years ago, minimally invasive (focused)
parathyroidectomy (MIP) has been proposed by Sten Tibblin from Lund (Sweden).
Nowadays, this approach has become the ‘standard of care’ in the modern management
of sPHPT. MIP is guided based on results of preoperative localization studies
(PLSs, typically, ultrasonography and Tc99m-sestamibi scan). However, bilateral
neck exploration in sPHPT is still indicated:
1.IF BOTH
PLSs ARE NEGATIVE - bilateral neck exploration should be performed without the
need for further imaging
2.IF
RESULTS OF PLSs ARE NOT CONCORDANT - in this case MIP or unilateral neck
exploration using intraoperative parathormone levels monitoring could be
another alternative
3.IF
PREOPERATIVE IMAGING (ULTRASONOGRAPHY) REVEALS THYROIDOPATHY REQUIRING
CONCOMITTANT THYROIDECTOMY
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