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BackgroundSingle parathyroid adenoma is the commonest cause of primary hyperparathyroidism. Localization of the affected gland preoperatively is a critical step in management. Surgery is considered as the main line of treatment for single parathyroid adenoma. Focused technique for parathyroid excision was found by many researchers to have a good success rate even without intraoperative parathyroid hormone measurement.ObjectiveThe aim of this study was to assess the feasibility, safety, and adequacy of focused parathyroidectomy via an open lateral approach using preoperative positive Sestamibi (MIBI) scan and/or ultrasound without utilizing any intraoperative aiding tools.MethodsA case-series prospective analysis of focused open parathyroidectomy for 20 patients presented to the department of surgery or referred from the orthopedic department between October 2012 and January 2015 at the Faculty of Medicine, Al-Azhar University, Cairo, Egypt, diagnosed as sporadic hyperparathyroidism with either positive MIBI scan or ultrasound were done. Normalization of the postoperative levels of serum calcium and PTH was considered as a marker of success. Data entry and analysis were done using the IBM-SPSS version 22.ResultsIn this study, focused minimal access parathyroidectomy was successful in 95% with no major surgical complications, i.e., recurrent laryngeal nerve palsy or permanent hypoparathyroidism. The patient’s mean age was 46.5±12 years. The preoperative serum calcium level ranged from 8.8 to 15.2 mg/dL. The parathyroid hormone level was elevated ranging from 123–2000 pg/mL. In 90% of the cases, serum levels of alkaline phosphatase were elevated, while serum phosphorus was low with range 1.5–4.7 mg/dL. The left inferior parathyroid gland was the most commonly involved gland (40%). Using ultrasound and Sestamibi scan for preoperative localization was accurate in 75% and 90%, respectively. When both techniques were combined localization accuracy increased to 95%.ConclusionOur study has shown that focused parathyroidectomy is considered as a good option for single gland disease even if there are no available intraoperative helping aids, provided that good patient selection is undertaken.

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Background Total thyroidectomy is a common procedure, we wish to examine the effects of utilizing a harmonic scalpel with traditional procedures on parathyroid hormone levels. Patients and methods 100 patients who underwent total thyroidectomy at the Department of General Surgery, were enrolled in this prospective randomized study, were randomly allocated into two equal groups: Group I: total thyroidectomy using a harmonic scalpel (HS) and Group II: total thyroidectomy using conventional technique. Results There is a significant association between the technique of surgery and the decrease in Postoperative PTH, Mean Difference, Pre and Postoperative and the change Pre PTH (p-value <0.001). Conclusion The postoperative serum level of parathyroid hormone declined significantly after thyroidectomy if the conventional method was used. Using HS during thyroidectomy is safe and effective with low rates of hypoparathyroidism.