Endocrine

Parathyroidectomy (Four-Gland Exploration)

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.

Incision: Transverse Kocher skin crease incision.

Procedure:
1. Skin and platysma incised. Subplatysmal flaps raised. Strap muscles retracted.
2. Thyroid lobe retracted medially. All four parathyroid glands systematically identified: superior glands (posterior, near the cricothyroid junction), inferior glands (near the inferior thyroid pole, in the thyrothymic ligament).