Özet:

The only curative treatment of primary hyperparathyroidism (pHPT) is the surgeon. The most important factors that increase the rate of success in parathyroidectomy is the correct diagnosis and that the surgeon has good anatomy and embryonic logic knowledge. The lower parathyroid glands develop from the third pharyngeal pocket, while the upper parathyroid glands develop from the dorsal part of the fourth pharyngeal pocket. There are typically four parathyroids in humans. In large autopsy series, four between 80-93% and more than four between 3.7-13% (super-number glands) and less than four between 2-13% parathyroids were detected. The typical location of the upper parathyroids is in the posterolateral area of the mid and upper part of the thyroid 1/3 and the typical location of the lower parathyroids is in the lateral, lateral or antero-lateral area of the thyroid subpole, within a diameter of 1cm. Parathyroids are not rare to be found ectopically in different anatomical areas, except in the normal settlements in the form of embryological ectopy, depending on embryological abnormal migration and on the migration of congenital ectopy and grown parathyroids. Despite the identification of different surgical techniques in the surgical treatment of hyperparathyroidism, two basic surgical options that can be used are more limited surgeons that can be gathered under the name of bilateral neck exploration (BBE) and minimal invasive parathyroidiektomy (MIP). MIP can be applied as open, endoscopic or video-assisted (MIVAP) and is usually adjusted to lateral open MIP. Endoscopic or robotic parathyroidectomy methods from remote areas outside the neck are also. While MIP is the standard treatment option in selected patients that are presently positive, BBE in parathyroid surgery retains its place as a standard initiative. In 80% to 90% of patients with pHPT, pathological parathyroid glands can be identified by preoperative imaging methods and MIP can be applied. However, patients with MIP may not be found pathological glands due to mispositivity. Therefore, the parathyroid surgeon should know well the BBE technique as well as the MIP technique and be practical, and should be able to move to the BBE by changing the strategy if necessary. If the sought parathyroid cannot be found in a normal anatomical location, the potential embryological and edental ectopic settlements of the gland are examined. In parathyroid surgery, it is worth forgotten that MIP and BBE are not an alternative to each other, but techniques that complement each other for successful treatment. (SETB-2019-08-113)

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