[New directions in the surgical treatment of primary hyperparathyroidism].

For a long time, bilateral cervicotomy with a scrupulous exploration of the sites of the parathyroid glands was the technique of choice in the treatment of primary hyperparathyroidism. Recently new less invasive surgical techniques appeared: unilateral approach under local anaesthesia (UA LA) and video endoscopic parathyroidectomy (VEP), which could be used in 50% of patients after elimination of contraindications. Three factors support these new techniques: HPT I is in 85% of the patients related to a solitary adenoma. Ultrasonography or scintigraphy isolated or associated can detect the adenoma. Peroperative monitoring of the PTH can control the success of surgery. In our experience, 95 to 98 per cent of patients are cured of their HPTI.... In our opinion, UALA, technically simpler, with long term good results, is the technique of choice.