title: [Parathyroid adenoma: surgical strategy].
abstract: OBJECTIVE
  The purpose of this study is to reach a better understanding in the handling of parathyroid adenomas, and to emphasize the importance of pre-operatory explorations in order to establish the best surgical approach and its cost.
  
  
  METHODS
  We are using a retrospective study of 51 patients that underwent surgery in our department between the years 1997 and 2002, for the treatment of primary hyperparathyroidism. Every patient received to a pre-operatory exploration in order to localize the parathyroid tumors, including cervical echography in 51 of the cases, and a sestamibi scintigraphy in 49 of the cases. Two surgical procedures were performed: unilateral approach, and bi-lateral approach.
  
  
  RESULTS
  The implementation of a systematic pre-surgical checkup allowed for unilateral surgery in 76% of the patients (39 out of 51), from which 31% (12 out of 39) under local anesthesia.
  
  
  CONCLUSIONS
  The accuracy of the pre-operatory explorations in order to localize the parathyroidian tumors in regard to HPTP, allows for precise surgery via unilateral approach under local anesthesia. The benefits are significant with shorter procedure time, shorter patient hospitalization, and lower risks for complications. The pre-operatory explorations also decrease the total cost of the procedure and are a critical tool for the surgeon.
authors.affiliation: Service d'ORL et de Chirurgie Cervico-Faciale, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75908 Paris cedex 15, France. david.malinvaud@egp.aphp.fr
authors.forename: D
authors.initials: D
authors.lastname: Malinvaud
authors.forename: G
authors.initials: G
authors.lastname: Potard
authors.forename: C
authors.initials: C
authors.lastname: Martins-Carvalho
authors.forename: J A
authors.initials: JA
authors.lastname: Jézéquel
authors.forename: R
authors.initials: R
authors.lastname: Marianowski
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009333:Neck / Q000000981:diagnostic imaging; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi