Parathyroid surgery: we still need traditional and selective approaches.

Since the first parathyroidectomy in 1925, the traditional bilateral cervical approach has been the gold standard surgical treatment for patients with primary hyperparathyroidism, with a success rate >95%. Over the past decade, the focus on minimally invasive surgery has led to the development of several innovative approaches to the parathyroid glands including the focused, radio-guided, video-assisted and videoscopic parathyroidectomy. Improvements in pre-operative parathyroid localization studies as well as the use of the intraoperative PTH assay have made these minimally invasive approaches possible, and they have been proven to be safe and effective for the solitary parathyroid adenoma. For patients with multiple gland disease or equivocal localization studies, the traditional bilateral approach remains the standard of care.