Techniques of parathyroid exploration at North American endocrine surgery fellowship programs: what the next generation is being taught.
BACKGROUND
Minimally invasive techniques are now often used to treat primary hyperparathyroidism but with uncertain conformity and some controversy. Endocrine surgery fellowships (ESFPs) have recently proliferated.


METHODS
The directors of the 19 ESFPs recognized by the American Association of Endocrine Surgeons were polled to identify the approaches currently taught to trainees.


RESULTS
With 100% participation, all ESFPs obtain ≥1 imaging study, and 95% use ultrasound to assess for concurrent thyroid nodules that require care. For an apparent single adenoma, all ESFPs minimize dissection, use intraoperative parathyroid hormone monitoring, and, if multiglandular disease is identified, perform 4-gland exploration. Outpatient surgery (89%) and postoperative oral calcium use (68%) are common. All programs define cure as durable normocalcemia (median, 6 months).


CONCLUSIONS
American Association of Endocrine Surgeons fellowship programs teach congruent management strategies that include focused dissection, intraoperative parathyroid hormone use, and intent to cure. These consistencies define a future standard for assessment of parathyroidectomy outcomes.
Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
Tracy S
TS
Wang
Department of Surgery, University of Calgary, Calgary, AB, Canada.
Janice L
JL
Pasieka
Department of Surgery, University of Pittsburgh, 3471 Fifth Avenue, Kaufmann 101, Pittsburgh, PA 15213, USA. Electronic address: cartyse@upmc.edu.
Sally E
SE
Carty
D004502:Education, Medical, Continuing / Q000379:methods*; D004704:Endocrinology / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D019060:Minimally Invasive Surgical Procedures / Q000193:education*; D009656:North America; D010279:Parathyroid Diseases / Q000601:surgery*; D016105:Parathyroidectomy / Q000193:education*; D016730:Program Development; D012955:Societies, Medical
Endocrine surgery; Fellowship programs; Minimally invasive parathyroidectomy; Primary hyperparathyroidism