Parathyroidectomy

• • Minimmaly invasive parathyroidectomy will require preoperative localization and intraoperative PTH (IOPTH).

  • Four gland exploration is safe for board answer, but still do one side at a time.

  • Normal parathyroid glands are about 3mm diameter and 60mg weight

Preoperative Details

• 1. Position with arms tucked, shoulder roll, head extended.

  2. No paralytics.

Operative Details

• 1. Incision one finger breath below cricoid in a horizontal skin line.

  2. Mobilize subplatysmal skin flaps cranialy to thyroid cartilage and caudally to sternal notch.

  3. Incise median raphae in the midline and mobilze strap muscles laterally.

  4. Identify superior parathyroid.

  5. Identify recurrent laryngeal nerve and preserve

  6. Identify inferior parathyroid.

  7. Remove the disease parathyroid

• • Perform bilateral exploration if no IOPTH available.

  • Close strap muscles.