Parathyroid surgery: we only need a minimal surgical approach.

Minimally invasive surgery for the treatment of primary hyperparathyroidism is currently used by the greatest majority of authors. Extensive literature has shown that results and complication rates are comparable to those obtained by extensive neck bilateral exploration performed via standard open surgery. Neither recurrence rate nor persistence rate have increased over the last 7 yr since the introduction of these minimal access procedures. The dramatic improvement of localization studies and the introduction of intraoperative parathyroid hormone measurement constitute the basis for this change of attitude among surgeons; the shift has also been supported by the utilization of the new endoscopic techniques recently introduced. Bilateral neck exploration now seems to be confined only to a slight minority of patients, in particular when a reoperation or the removal of a big goiter is needed.