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Langenbeck's Archives of Surgery

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01-05-2008 | Current Concepts in Endocrine Surgery

Surgery for sporadic primary hyperparathyroidism: controversies and evidence-based approach

Authors: Antonio Sitges-Serra, Prieto Rosa, Mónica Valero, Estela Membrilla, Joan J. Sancho

Published in: Langenbeck's Archives of Surgery | Issue 3/2008

Abstract

Introduction

Sporadic primary hyperparathyroidism is due to single adenoma in over 90–95% of instances. Careful medical history and precise preoperative identification of the enlarged gland by parathyroid Tc-mibi scintigraphy and neck ultrasound allow selecting patients for minimally invasive parathyroidectomy, a focused intervention with minimal skin opening and tissue dissection. Small (<300 mg) adenomas continue to challenge preoperative imaging, and most of them will still require a bilateral exploration.

Conclusion

Surgery should never be indicated on the basis of positive or negative preoperative localization studies. Intraoperative quick parathyroid hormone measurements seem particularly helpful for cases with equivocal localization studies. The best minimal access approach is still a matter of debate, and options include small central incision, video-assisted parathyroidectomy, minimal lateral open approach, and purely endoscopic access via lateral approach. Radioguided surgery does not seem to have a role in routine cases but may be useful to find adenomas during reintervention on scarred difficult surgical fields.

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Title: Surgery for sporadic primary hyperparathyroidism: controversies and evidence-based approach
Authors: Antonio Sitges-Serra
Prieto Rosa
Mónica Valero
Estela Membrilla
Joan J. Sancho
Publication date: 01-05-2008
Publisher: Springer-Verlag
Published in: Langenbeck's Archives of Surgery / Issue 3/2008
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-008-0283-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Surgery for sporadic primary hyperparathyroidism: controversies and evidence-based approach

Abstract

Introduction

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Conclusion

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