Parathyroid Surgery Approach

The focused lateral mini-incision parathyroidectomy provides the most direct access to the parathyroid glands with a minimum of tissue manipulation. A 2cm incision is made directly over the abnormal parathyroid gland. Because over 90% of patient's with primary hyperparathyroidism have a single parathyroid adenoma it is not necessary to explore all 4 glands in most cases. A successful preoperative parathyroid imaging localization of a single parathyroid adenoma is necessary for us to use this approach. Also, the patient's neck skin anatomy should demonstrate that the lateral approach is aesthetically superior to a midline mini-incision. Each case is judged individually. There are cases where we decide a mid-line incision would be more advantageous. If there are multiple adenomas, we do not use this approach as we may require access to visualize both sides of the neck. If preoperative imaging does not demonstrate the adenoma, we do not use this approach as a bilateral traditional neck exploration may be necessary. If there is concurrent thyroid disease or nodules that need exploration or surgical intervention, then we use a midline approach.