[Minimally invasive surgery versus bilateral neck exploration for primary hyperparathyroidism: controlled prospective study. Role of intraoperative rapid parathyroid hormone assay and radiological preoperative detection of adenomas].

There is considerable controversy today concerning the most appropriate surgical approach for patients with primary hyperparathyroidism. The standard surgical approach involves a bilateral neck exploration. Minimally invasive surgery involves the removal of one parathyroid gland, pre-surgically localized with radiological techniques. Our purpose was to evaluate and compare the results of the 2 different surgical management in a follow-up period of observation. In our series of 15 consecutive female patients who underwent surgery, 5 (group I) underwent mini-invasive and 10 (group II) bilateral neck surgery. The first 10 were random selected to surgery; the successive 5 were assigned at group II. The normalization of calcemia was obtained in 100% of the women in group I and in 100% of the women in group II. Four patients of group I and two of group II had elevated PTH levels after surgery. Minimally invasive surgery for primary hyperparathyroidism depends on accurate preoperative localization of adenoma and the availability of IOPTHa for monitoring decrease of PTH concentration during surgery, while the IOPTHa is useless in case of conventional surgical operation. The data suggest that a focused unilateral surgical approach for hyperparathyroidism may underestimate the incidence of multiple-gland disease with persistent increase of PTH but not of calcemia. This technique may be useful for selected patients, older and without MEN syndrome.