Minimally Invasive Parathyroidectomy: Back-Door Approach

Reoperative parathyroidectomy after previous neck exploration for primary hyperparathyroidism (PHP) can be either due to persistent disease after failed surgery or disease recurrence after many years of normocalcemia. This procedure is usually associated with a reduced chance of success and a higher risk of complications. The most common causes for a failed exploration which then requires reoperative surgery are deep superior parathyroid adenomas, hyperplasia of one or more of the parathyroid glands including double adenoma, and ectopic adenomas and/or supernumerary adenomas. Preoperative localization facilitates preoperative identification of the location of the parathyroid adenoma and is essential prior to embarking on surgery (unlike primary surgery). Rapid intraoperative parathyroid hormone (ioPTH) monitoring provides real-time evidence of biochemical cure, reducing the likelihood of missing a hyperfunctional parathyroid gland. This chapter describes a minimally invasive parathyroidectomy by useing back-door approach.