{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T06:30:58Z","timestamp":1774852258919,"version":"3.50.1"},"reference-count":43,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2004,10,21]],"date-time":"2004-10-21T00:00:00Z","timestamp":1098316800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2004,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Selected patients with primary hyperparathyroidism (pHPT) who have a positive preoperative sestamibi scan can be managed safely and successfully with a focused cervical exploration without either adjuvant intraoperative parathyroid hormone (PTH) monitoring or use of a gamma probe. This article reports a retrospective analysis of a consecutive series of patients surgically treated at a tertiary referral center. From August 1998 to August 2002, 100 patients (68 women, 32\u00a0men; mean age 63 years [range: 29\u201389 years]) underwent a focused cervical approach without intraoperative PTH monitoring or use of the gamma probe after perioperative sestamibi injection. The study group comprised 9% of all patients (<jats:italic>n<\/jats:italic> = 1063) undergoing cervical exploration for pHPT during the study period. Ninety patients underwent an initial exploration, and 10 others underwent repeat cervical exploration following prior parathyroid (<jats:italic>n<\/jats:italic> = 7) or thyroid (<jats:italic>n<\/jats:italic> = 3) operation. Sestamibi scanning correlated with one enlarged parathyroid gland in all patients. Other enlarged glands were, however, not demonstrated in three patients (true positive = 97%; false negative = 3%). The single enlarged glands excised in all patients had a mean weight of 795\u00a0mg (range: 90\u20133640) and were histologically compatible with an adenoma. Postoperatively, 97% of patients were eucalcemic. Three patients remained hypercalcemic (3%). Of the three patients with persistent hypercalcemia, one underwent successful re\u2010exploration with excision of a 500\u00a0mg second adenoma, whereas the other two patients (with confirmed familial HPT) remained hypercalcemic. Mean hospitalization was 0.5\u00a0days (range: 0\u20133\u00a0days). There was no operative mortality. No patients had permanent hypocalcemia. Postoperative morbidity occurred in three patients: two self\u2010limiting cervical hematomas and one permanent vocal cord paralysis. Selected patients with pHPT due to single\u2010gland disease and an unequivocally positive preoperative sestamibi scan can safely and successfully be managed with a focused unilateral cervical exploration without either intraoperative PTH monitoring or use of the gamma probe. Further experience with this surgical approach seems warranted to determine the overall cure rate, operative morbidity, and the sensitivity and specificity of preoperative localization studies.<\/jats:p>","DOI":"10.1007\/s00268-004-7469-2","type":"journal-article","created":{"date-parts":[[2004,10,14]],"date-time":"2004-10-14T21:23:41Z","timestamp":1097789021000},"page":"1127-1131","source":"Crossref","is-referenced-by-count":53,"title":["Focused Cervical Exploration for Primary Hyperparathyroidism without Intraoperative Parathyroid Hormone Monitoring or Use of the Gamma Probe"],"prefix":"10.1002","volume":"28","author":[{"given":"Steven R.","family":"Jacobson","sequence":"first","affiliation":[{"name":"Division of Gastroenterologic and General Surgery Mayo Clinic and Mayo Foundation 200 1st Street, SW Rochester Minnesota 55905 USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jon A.","family":"van Heerden","sequence":"additional","affiliation":[{"name":"Division of Gastroenterologic and General Surgery Mayo Clinic and Mayo Foundation 200 1st Street, SW Rochester Minnesota 55905 USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David R.","family":"Farley","sequence":"additional","affiliation":[{"name":"Division of Gastroenterologic and General Surgery Mayo Clinic and Mayo Foundation 200 1st Street, SW Rochester Minnesota 55905 USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clive S.","family":"Grant","sequence":"additional","affiliation":[{"name":"Division of Gastroenterologic and General Surgery Mayo Clinic and Mayo Foundation 200 1st Street, SW Rochester Minnesota 55905 USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geoffrey B.","family":"Thompson","sequence":"additional","affiliation":[{"name":"Division of Gastroenterologic and General Surgery Mayo Clinic and Mayo Foundation 200 1st Street, SW Rochester Minnesota 55905 USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian P.","family":"Mullan","sequence":"additional","affiliation":[{"name":"Department of Radiology Mayo Clinic and Mayo Foundation 200 1st Street, SW Rochester Minnesota 55905 USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathleen J.","family":"Curlee","sequence":"additional","affiliation":[{"name":"Department of Surgery Mayo Clinic and Mayo Foundation 200 1st Street, SW Rochester Minnesota 55905 USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2004,10,21]]},"reference":[{"key":"e_1_2_8_2_2","first-page":"1343","article-title":"Therapeutischer Versuch bei Ostitis fibrosa generalisata mittels Exstirpation eines Epithelk\u00f6rperchentumors","volume":"38","author":"Mandl F","year":"1925","journal-title":"Wien. 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