- 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
- Position with arms tucked, shoulder roll, head extended.
- No paralytics.
- Incision one finger breath below cricoid in a horizontal skin line.
- Mobilize subplatysmal skin flaps cranialy to thyroid cartilage and caudally to sternal notch.
- Incise median raphae in the midline and mobilze strap muscles laterally.
- Identify superior parathyroid.
- Identify recurrent laryngeal nerve and preserve
- Identify inferior parathyroid.
- Remove the disease parathyroid
- Perform bilateral exploration if no IOPTH available.
- Close strap muscles.