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September 1, 2003

Continuing Evolution of the Truly Minimally Invasive Parathyroidectomy

Arch Surg. 2003;138(9):1024. doi:10.1001/archsurg.138.9.1024

Sackett et al1 are to be congratulated on their timely survey of minimally invasive techniques currently used by endocrine surgeons worldwide for parathyroidectomy. Indeed, parathyroidectomy has been fast evolving, as evidenced by a plethora of landmark articles in the past decade.2 Sackett et al state that the 3 "earliest reports" of minimally invasive parathyroidectomy (MIP) described the use of a true endoscopic technique. Notably, the first 2 references were duplicated reports of the same case, and the third reference was published in 1999. I described the totally endoscopic technique and its results as early as 1997 and 1998.2 However, after a brief period of enthusiastic application, I shifted to a nonendoscopic direct approach via a mini-incision in a neck wrinkle because most patients were elderly. The endoscopic approach is now reserved for those few young patients with a superior parathyroid gland deeply located around the upper pole of the thyroid, where superior exposure is afforded by my technique; besides, a scar high up on a smooth neck would stand out prominently.

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