Parathyroidectomy: Overview of the Anatomic Basis and Surgical Strategies for Parathyroid Operations

摘要

It is imperative for the surgeon who performs parathyroidectomy to have a thorough understanding of the anatomy and embryology of the parathyroid glands in order to optimize the cure rate for patients with hyperparathyroidism (HPT). Furthermore, all clinicians caring for patients with hyperparathyroidism should be aware of the advancements in preoperative parathyroid localization, intraoperative PTH monitoring and surgical strategies for treatment of hyperparathyroidism. In this chapter, the anatomy and embryology of the parathyroid glands will be reviewed. The available surgical options for treatment of patients with hyperparathyroidism will be addressed, including “focused” parathyroidectomy, bilateral neck exploration, radioguided parathyroidectomy, and endoscopic and video-assisted parathyroidectomy. The unique challenge associated with reoperative parathyroidectomy for persistent or recurrent hyperparathyroidism will be outlined. Finally, insight into how to locate a qualified surgeon will be provided and recommendations will be made on what constitutes an appropriate choice of operation for specific patients with primary hyperparathyroidism.