Parathyroidectomy at ito hospital: a review of a thyroid clinic in Japan.

We primarily describe surgical methods and short-stay surgery, which has been recently attracting interest in Japan, in relation to the diagnosis and treatment of parathyroid disease at a special hospital for thyroid diseases. There is a controversy in regard to surgical methods for primary hyperparathyroidism (PHPT), whether it is sufficient to examine only one side or all four glands should be checked. At our hospital, we selected one of the following three different approaches depending on the case: where the lesion was excised after checking all four glands on both sides (Method A), where the lesion was excised after checking two glands by examining one side (Method B), and where the lesion of one gland was directly excised (Method C). A review of the initial operations for 185 cases of PHPT treated at our hospital over 18 years revealed that the patients who underwent Methods B and C under local anesthesia had developed no complications and their long-term postoperative outcome was also favorable. In the future we also intend to adopt the unilateral approach aggressively under local anesthesia and perform short-stay surgery in cases which pathological parathyroid glands have been discovered by preoperative localization.