Over the years surgery for primary hyperparathyroidism has evolved from bilateral neck exploration to focus unilateral approach. This has been made possible by the advancement in localization technique and availability of the preoperative imaging. This study aimed to determine the feasibility and accuracy of focus unilateral neck approach for primary hyperparathyroidism with surgeon- performed ultrasound as the main decisive preoperative localization imaging technique.

The decision of focus unilateral approach was stipulated if an enlarged parathyroid adenoma was confidently seen in the preoperative localization by surgeon-performed ultrasound. The focus unilateral exploration was terminated if the diseased gland was found. Nonetheless if in doubt, the exploration was extended to include the opposite side of the neck. More importantly any negative preoperative ultrasound will be considered for bilateral neck exploration.

118 consecutive patients were accrued in this study, 76 females and 42 males with mean age of 50 years. Focus unilateral neck exploration was performed on 86 (72.9%) patients and 96.5% of them were successfully explored and cured. 13 (13.1%) patients had exploration of both sides of the neck although the initial decision was only to explore one side. The overall cure rate was 93.2% with the sensitivity and specificity of ultrasound were 78.3% and 95.1% respectively.

Surgeon-performed ultrasound in parathyroid localization in coupled with focus unilateral approach in primary HPT can be performed 73% of patients with a success rate of more than 96%.