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Invited Critique
May 16, 2011

How Many Criteria Does It Take to Remove a Single Parathyroid Gland?Comment on “Critical Role of Identification of the Second Gland During Unilateral Parathyroid Surgery”

Author Affiliations

Author Affiliation: Office of Surgical Education, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts.

Arch Surg. 2011;146(5):516. doi:10.1001/archsurg.2011.77

The traditional answer is 1 criterion, with 4-gland exploration finding a single adenoma and 3 normal glands. But over the last 20 to 30 years, there has been an increasing impetus to limit surgical exploration, fueled by a series of innovations. These methods to identify a single adenoma and to facilitate intraoperative decision making are MIBI imaging, high-resolution US, and rapid IOPTH. MIBI imaging is widely used, but IOPTH is not available at every institution, not all imaging systems are enhanced with single-photon emission computed tomography, and all ultrasonographers are not created equal, nor are all necks created equal in the eyes of the ultrasonographer.

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