title: Directed parathyroidectomy: feasibility and performance in 100 consecutive patients with primary hyperparathyroidism.
abstract: OBJECTIVE
  Directed parathyroidectomy (DP) can be successfully completed in most patients with primary hyperparathyroidism.
  
  
  METHODS
  Retrospective review at a tertiary referral center.
  
  
  METHODS
  One hundred consecutive patients with untreated, sporadic primary hyperparathyroidism operated on by a single surgeon from April 1, 1999, through December 31, 2001.
  
  
  METHODS
  Following preoperative imaging with sestamibi scintigraphy and ultrasonography, patients underwent parathyroidectomy with intraoperative parathyroid hormone monitoring using a focused approach through a limited neck incision (DP) or bilateral neck exploration (BNE) through a standard collar incision.
  
  
  METHODS
  Extent of exploration, operative time, length of stay, morbidity, and cure.
  
  
  RESULTS
  Directed parathyroidectomy was completed in 70 patients and BNE in 30. Bilateral neck exploration was performed as the initial procedure in 13 patients and following intraoperative conversion from attempted DP in 17. Indications for predetermined BNE were failed preoperative localization (n = 8) and concomitant thyroid disease that required operative treatment (n = 5). The need for predetermined BNE decreased as preoperative localization improved. Intraoperative factors that necessitated conversion to BNE included persistently elevated intraoperative parathyroid hormone levels that accurately predicted multiglandular disease (n = 6), incorrect localization (n = 5), and inadequate exposure (n = 6). Operative time and length of stay were less for DP compared with BNE patients (66 vs 165 minutes and 0.5 vs 1.6 days, respectively). One patient had a temporary vocal cord paresis. All patients were eucalcemic in follow-up (4 months to 3 years).
  
  
  CONCLUSIONS
  With accurate preoperative localization and intraoperative parathyroid hormone monitoring, DP can be successfully completed in most patients with sporadic primary hyperparathyroidism. Patients benefit from DP, which reduces operative time and length of stay and facilitates rapid convalescence.
authors.affiliation: Department of Surgery, The University of Texas Southwestern Medical Center, Dallas 75390, USA. william.snyder@utsouthwestern.edu
authors.forename: Shelby H
authors.initials: SH
authors.lastname: Burkey
authors.forename: William H
authors.initials: WH
authors.lastname: Snyder
authors.forename: Fiemu
authors.initials: F
authors.lastname: Nwariaku
authors.forename: Lori
authors.initials: L
authors.lastname: Watumull
authors.forename: Dana
authors.initials: D
authors.lastname: Mathews
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy / Q000379:methods*; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D010281:Parathyroid Hormone