A 38-year-old woman with primary hyperparathyroidism has concordant sestamibi and ultrasound localizing a single right inferior parathyroid adenoma. What is the most appropriate surgical approach?
- A Subtotal parathyroidectomy removing 3.5 glands
- B Bilateral neck exploration with visualisation of all four glands
- C Focused parathyroidectomy (minimally invasive) without four-gland exploration ✓
- D Total parathyroidectomy with forearm autotransplantation
Correct answer: C. Focused parathyroidectomy (minimally invasive) without four-gland exploration
Explanation
When preoperative imaging (sestamibi and ultrasound) concordantly localizes a single adenoma, focused (minimally invasive) parathyroidectomy is the standard approach. It is performed through a smaller incision without routine four-gland exploration, and intraoperative PTH monitoring confirms cure. Bilateral exploration is reserved for negative or discordant imaging or multigland disease.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
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