Operative technique in primary hyperparathyroidism

The aim of surgical intervention in the treatment of primary hyperparathyro idism (pHPT) is the achievement of normocalcemia and euparathyreosis. Despi te improved diagnostic procedures containing comparatively modified pre- an d intraoperative methods to determine the position of the parathyroid gland s and the most efficient operative technique including minimal-invasive sur gery thereof, success cannot be guaranteed. Therefore, we should strive to avoid reintervention by ensuring a hemorrhage-free, atraumatic, anatomical- orientated operation and providing positive preconditions for reoperation. Success is based on the four pillars of the HPT surgery: history, embryolog y with anatomy, neck surgery and experience. By means of this principle and the results of surgical treatment in 1634 patients with pHPT from 1982 unt il 1998, we demonstrate a standardized operative technique of pHPT.