Minimally invasive endoscopic selective parathyroidectomy.

Primary hyperparathyroidism is a common condition with surgery being the definitive treatment modality. Controversy exists over the extent of optimal neck exploration, whether unilateral or bilateral exploration should be performed, particularly since 85-90% of primary hyperparathyroidism results from single gland disease. Unilateral neck exploration is now considered to be adequate unless a definitive adenoma is not identified on ipsilateral exploration and where the serum intact Parathyroid Hormone (iPTH) level does not show a decline greater than 60% after removal of a suspected adenoma. It also avoids the potential risk of hypocalcaemia, recurrent laryngeal nerve injury along with extended anaesthesia and operative time and in-patient stay. With the advent of advanced imaging modalities and peri-operative localization techniques the hyper-functioning gland can be identified and minimally invasive procedures can be performed, limiting the neck exploration to only the abnormal gland. Here we would like to describe our procedure for a minimally invasive endoscopic selective parathyroidectomy, performed on five patients. We describe our standard setup, procedure and the outcomes.