ABSTRACT
Primary hyperparathyroidism (PHPT) is a disease characterized by elevated serum calcium and parathyroid hormone (PTH) levels. It is a common disorder although multiple factors can influence its incidence such as regional influences, nutritional status, the availability of routine biochemical screening, sex, previous irradiation and age. The only cure for PHPT is to surgically remove the hyperfunctioning parathyroid adenoma or adenomata or to reduce the bulk of parathyroid tissue in patients with hyperplasia. The historical evolution of surgery for PHPT, as well as the surgical strategies after operative failure, can be considered in three distinct phases. The first phase was the 'learning curve'. The second phase was the open four-gland exploration approach. The third and current phase of minimally invasive parathyroidectomy (MIP) was ushered in with the report of the first endoscopic parathyroidectomy by M. Gagner in 1996. The most significant complication of reoperative parathyroid surgery is a recurrent laryngeal nerve injury, resulting in vocal cord paralysis.
