The surgical approach to patients with primary hyperparathyroidism continues to be controversial. While Dr. Udelsman and colleagues believe that target or minimally invasive parathyroidectomy is optimal, a poll of the participants in this journal club suggest otherwise. In fact, by a ratio of 3:1, our readers do not agree with Dr. Udelsman’s conclusions and prefer bilateral exploration. Interestingly, there are data from multiple institutions, including our own, that with longer term follow-up minimally invasive parathyroidectomy may be associated with a slightly higher recurrence rate. In any case, in the hands of experienced surgeons, both techniques have been proven to be effective and safe. I think all surgeons can agree that the most effective therapy for patients with primary hyperparathyroidism is parathyroidectomy, and collectively we should advocate for referral of all patients with this disease for surgery.
-Herb Chen, MD