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Despite evolving guidelines, real-life management remains variable across centers. A national survey was conducted among members of the Italian Society of Endocrine Surgery (SIUEC) to evaluate current practices in PHPT surgery, including the use of minimally invasive approaches and intraoperative parathyroid hormone (ioPTH) monitoring. Eighty-eight endocrine surgeons participated. Minimally invasive parathyroidectomy was the preferred approach, especially among high-volume surgeons. ioPTH was used by 83% of respondents, although its necessity in cases with concordant imaging was debated. Cervical ultrasound and\n                    <jats:sup>99m<\/jats:sup>\n                    Tc-sestamibi were routinely used for localization; choline PET\/CT was employed selectively. Significant differences emerged between low- and high-volume surgeons in surgical technique, ioPTH timing, and use of neuromonitoring. The survey highlights heterogeneity in the management of PHPT in Italy, suggesting room for standardization and broader guideline adherence. Efforts are needed to promote uniform, evidence-based practices nationwide.\n                  <\/jats:p>","DOI":"10.1007\/s13304-025-02430-8","type":"journal-article","created":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T09:29:03Z","timestamp":1761125343000},"page":"351-363","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Parathyroidectomy and the use of ioPTH. 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