KAREN H.CALHOUNMDRONALD B.KUPPERSMITHMD
CONTROVERSY surrounding unilateral vs bilateral exploration for nonsyndromic primary hyperparathyroidism has persisted for many decades, and I believe that the debate will continue for some time. Previously, this debate seemed to focus on the frustrations of one's ability to localize an abnormal gland and consequently reduce the number of reexplorations. Today, it appears the debate has an inherent additional angle of cost-effectiveness for workup and its attendant management. The only thing we all agree on is the availability of an experienced parathyroid gland surgeon. I must remind readers that even the most prominent and experienced parathyroid gland surgeons differ in their approaches. Wang1 promoted unilateral exploration because he believed that the incidence of bilateral adenoma is very low (somewhat similar to that described by Petersen et al). Wang further believed that failures occurred because surgeons did not understand the normal and displaced locations of the glands, made errors in pathological diagnosis, and were not technically competent. On the other hand, Clark2 and Wells et al3 have promoted a bilateral approach in trying to achieve more than 95% success, with no increased morbidity of hypocalcemia.
Khan A. Unilateral vs Bilateral Parathyroid Gland ExplorationA Continuing Controversy. Arch Otolaryngol Head Neck Surg. 1998;124(9):1055. doi:10.1001/archotol.124.9.1055