Parathyroidectomy and Four-Gland Exploration for Hyperparathyroidism

1. Introduction

2. Incision

3. Exposure of Thyroid Gland and Overlying Strap Muscles

1. Subplatysmal Flaps
2. Separate Strap Muscles

4. Exposing and Exploring all Four Parathyroid Glands

1. Left Inferior Parathyroid with Removal: Most Suspicious on Pre-op Imaging
2. Left Superior Parathyroid
3. Right Inferior Parathyroid
4. Right Superior Parathyroid
5. Summary of Findings
6. Further Exploration of Left Superior Parathyroid
7. Re-evaluation and Preservation of Right Inferior Parathyroid
8. Re-evaluation and Removal of Right Superior Parathyroid
9. Summary of Progress and Comparison with Expectations from Pre-op Imaging
10. Return to Right Inferior Parathyroid Gland for Biopsy

5. PTH Check and Hemostasis with Surgicel

6. Closure and PTH Check

1. Sternohyoid Muscle with 4-0 Vicryl Interrupted Sutures
2. Platysma with 4-0 Vicryl Interrupted Sutures
3. Skin with Running, Knotless 5-0 Monocryl Subcuticular Suture and Steri-Strips

7. Post-op Remarks