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Bilateral Exploration

UW Health endocrine surgeons in Madison, Wisconsin, perform bilateral exploration, the traditional surgical approach to hyperparathyroidism. This procedure may also be referred to as:

  • Open parathyroidectomy
  • Standard parathyroidectomy
  • 4 gland exploration
  • Conventional parathyroidectomy

About Bilateral Exploration for Hyperparathyroidism

 

This approach has proven over time to be highly successful with cure rates of 95 percent when performed by an experienced surgeon. In order to be successful, the surgeon must identify all four parathyroid glands. This requires expertise in the recognition of the parathyroid glands in both their normal and unusual locations.

 

In the past, each parathyroid gland was biopsied to confirm that all glands were identified. However, due to the risk of injuring the blood supply to the parathyroid glands, biopsies of normal appearing glands is no longer recommended.

 

Pre-operative localization and special intraoperative adjuncts (such as intraoperative PTH testing or radioguidance) are not required, but are often used to guide the surgeon.

 

Traditionally a bilateral exploration was performed through a five to seven-inch incision. Endocrine surgeons Herbert Chen, MD and Becky Sippel, MD are able to do this operation through a much smaller one and one-half to two-inch incision.

 

The incision is usually located in the middle to lower portion of the neck and is curved to match the skin folds in your neck. Experienced surgeons understand the variations in anatomy that can exist and are very successful at finding parathyroids, even when they are not in their normal location. Parathyroids can be located behind the esophagus, in the upper chest, or even inside of the thyroid gland.

 

The goal of the first operation is to cure the patient of their hyperparathyroidism.

 

Identification of Glands

 

Since multiple abnormal parathyroid glands are found in 15 to 20 percent of patients, it is essential to make every effort to identify all four parathyroid glands. If only a single abnormal gland is identified, then it should be resected. If all four glands are abnormal then the treatment options are a subtotal parathyroidectomy (removal of three and one-half glands) or a total parathyroidectomy (removal of all parathyroid tissue) with autotransplantation of part of a parathyroid to the forearm.

 

An autotransplant involves placing several small pieces of parathyroid tissue into a muscle either in the neck of the arm. It will grow a new blood supply and will typically start functioning in four to six weeks.