PARATHYROIDECTOMY (FOUR-GLAND EXPLORATION)
Indication: Primary hyperparathyroidism when pre-operative localisation is equivocal or negative, multiglandular disease (hyperplasia), familial hyperparathyroidism, MEN1, or secondary/tertiary hyperparathyroidism in renal failure. Allows full assessment of all four glands.
Patient Position: Supine, neck extended.
Anaesthesia: General (or cervical block and sedation in selected patients).
Prophylactic Antibiotics: Not routinely required.