Unilateral neck exploration under local anesthesia: The approach of choicefor asymptomatic primary hyperparathyroidism

Background. Conventional parathyroidectomy involves a bilateral neck explor ation with the patient under general anesthesia with a thorough search for all parathyroid tissue. The purpose of this study was to assess the efficac y and safety of unilateral neck exploration under local anesthesia in patie nts with asymptomatic primary hyperparathyroidism (first-degree hyperparath yroidism). Methods. Of 679 patients who underwent parathyroidectomy for first-degree h yperparathyroidism from July 1989 to June 1997, 230 asymptomatic patients u nderwent unilateral neck exploration under local anesthesia. Selection crit eria for this approach included the successful identification of a solitary parathyroid adenoma on preoperative imaging no thyroid disease, and no fam ily history of multiple endocrine neoplasia. Intact parathyroid hormone lev els were monitored during the operation. Results. Total serum calcium levels were normal in 220 patients (96%) 3 to 6 months after surgery. Ten patients (4%) experienced persistent hypercalce mia, 8 of whom had multiple gland disease and 2 of whom had false positive imaging. Two of these patients underwent bilateral neck exploration under g eneral anesthesia and were cured, although 8 patients remained asymptomatic and were followed up nonoperatively. The mean operating time was 30 minute s (range, 12-65 minutes). There were two complications (0.87%) including on e wound hematoma and one transient recurrent laryngeal nerve palsy. Conclusions. Unilateral neck, exploration under local anesthesia is an effi cacious and safe approach to the treatment of first-degree hyperparathyroid ism and should be considered in all patients with asymptomatic disease.