Over recent years, various advanced minimally invasive techniques have been developed for parathyroidectomy, and there was a universal acceptance of these less invasive procedures by surgeons. This study was designed to compare overall outcomes between endoscopic versus focused, single gland parathyroidectomy using intraoperative rapid PTH (ioPTH) changes under general anesthesia in primary hyperparathyroidism (PHPT) patients

In this randomized clinical trial, patients diagnosed with PHPT were randomly assigned into two groups endoscopic and focused parathyroidectomy. Baseline clinical and demographical data were collected along with perioperative features. The success rate was evaluated based on ioPTH changes

Among 96 randomized patients, five were converted from endoscopic to unilateral exploration due to inadequate decrease of ioPTH levels in the first five and ten minutes of surgery, and therefore excluded from our study. The ioPTH levels after five minutes in the endoscopic group were significantly lower than the focused group (P=0.005). The success rate for endoscopic and the focused method was 95.3% and 77.1% during the first five minutes (P=0.013) and 100% in both groups after ten minutes. A decrease in parathyroid hormone levels was significant in each group but not between each other. Postoperative calcium levels were significantly lower in the focused method (P=0.042).The focused group also had a significantly shorter operation time than the endoscopic group (P<0.001)

The endoscopic technique was superior to the unilateral focused neck exploration parathyroidectomy in the management of PHPT. Influencing aspects included higher postoperative calcium levels, more rapid success achievement, and satisfactory cosmetic outcomes in the endoscopic group.