No Need to Abandon Focused Unilateral Exploration for Primary @entity2742 with Intraoperative Monitoring of Intact XXXX .

@entity1 @entity459 @entity9495 @entity460 @entity2742 @entity461
BACKGROUND: We investigated the rate of persistent and recurrent @entity2742 after focused unilateral exploration (UE) with intraoperative monitoring of intact @entity461 (IOPTH). STUDY DESIGN: A prospective cohort of 915 @entity1 with @entity459 ( @entity459 ) underwent parathyroid surgery by a single surgeon from January 2003 to September 2013. A total of 556 @entity1 with at least a single positive preoperative localization by ultrasound (US) and/or sestamibi scan (STS) underwent UE with IOPTH. The criterion for completion of surgery was an IOPTH fall of 50% from the highest intraoperative level and into the normal range 5 to 10 minutes after resection of the localized gland. RESULTS: Fifteen @entity1 had either persistent or recurrent @entity459 , yielding a 2.7% (95% CI 1.6% to 4.4%) overall recurrence rate based on the refined Wilson method with continuity correction. Four @entity1 had persistent @entity459 . Three of these @entity1 were cured with reoperation, and the fourth @entity1 was followed nonoperatively. Eleven @entity1 had recurrent @entity459 , with 5 corrected by surgery and 6 @entity1 followed nonoperatively. The mean postoperative serum @entity460 ( @entity9495 ) level was 9.4 mg/dL over a mean follow-up interval of 44.0 months. Preoperative localization rates by each localization study were: US 74.3% (n  = 413), STS 86.9% (n  = 483), and US and STS 71.4% (n  = 397). There was no difference in the preoperative study that localized the hyperfunctional parathyroid gland in recurrent vs nonrecurrent @entity1 by the Fisher's exact test (US, p  =1.00; STS, p  =0.65; US and STS, p  =1.00). CONCLUSIONS: The low rate of recurrent @entity459 after focused unilateral exploration with IOPTH suggests that this procedure should not be abandoned.
