The goals of operative treatment of primary hyperparathyroidism are (1) cur
e; (2) minimal invasion; and (3) cost-effectiveness. The optimal strategy i
s controversial. Retrospective review, of was undertaken 66 previously unop
erated patients having minimal-incision, full-neck exploration by one surge
on over 29 months. A group of 51 women and 15 men had open full neck explor
ation under general anesthesia through a small (25-40 mm) incision using sp
ecifically selected instruments; patients remained hospitalized overnight,
Preoperative sestamibi scans were obtained before referral for 17 patients:
11 had localized disease, and 6 did not (65% sensitivity). Four parathyroi
d glands were identified in 98% of patients; intraoperative frozen section
was used selectively on a median of one gland per patient. About 76% of pat
ients had single-gland disease, 6% had two-gland disease, and 18% had four-
gland hyperplasia, One patient had four normal cervical parathyroid glands
and an aorto-pulmonary window parathyroid adenoma resected at thoracotomy 1
week later; preoperative sestamibi scans failed to localize his disease, T
here mere no nerve injuries and a 98% cure rate after initial cervical expl
oration, Excluding the cost of the sestamibi scans, there was no difference
between those who had preoperative localization and these who did not; 60%
of hospital costs were operating room time-related, Minimal-incision parat
hyroidectomy is effective for curing hyperparathyroidism and has excellent
cosmetic results with negligible scar. Preoperative sestamibi scanning had
no impact on cure or treatment costs. Strategies to improve cost-effectiven
ess must address the substantial costs of anesthesia and operating room ser
vices.