ABSTRACT
The truism that the best opportunity to cure a patient with a surgical disease is at the initial operation is particularly self-evident in the treatment of primary hyperparathyroidism. The initial operative procedure in experienced hands is successful in at least 95% of cases and is associated with negligible potential morbidity and the great satisfaction of knowing that surgical cure will persist in the vast majority of instances (1). Reoperative surgery following a failed initial operation, or for recurrence following a more prolonged period of normocalcemia, presents far more formidable challenges for the surgeon. Indeed, the first patient treated surgically in the United States, Captain Charles Martell, a sea captain in the merchant marines with severe debilitating skeletal sequelae from primary hyperparathyroidism, had six unsuccessful cervical procedures that included excision of two normal parathyroid glands in search of a parathyroid adenoma beginning in 1926 (2). Finally, at the captain’s urging, a sternotomy in 1933 allowed the successful identification of a mediastinal parathyroid adenoma.
