The Evolution of Parathyroid Surgery

The Evolution of Parathyroid Surgery

Parathyroid gland discovery is accredited to Sir Richard Owen in 1850. Detailed studies on the glands included the work of eminent pathologist Virchow, helped to elucidate their physiology. The ‘glandulae parathyroideae’ were named in 1880 by Sandstrom from cadaveric studies. Surgery on the parathyroid glands was first performed in Vienna in 1925 by Mandl. A patient who had osteitis fibrosa cystica underwent a neck exploration for parathyroid adenoma. Since then, parathyroid surgery has developed, involving great surgical pioneers such as Bilroth, Kocker and Halsted in the early days and with a rapid evolution in the last decade. These recent advances can be attributed to a number of factors including increased specialisation and a trend towards minimally invasive surgery with a resultant reduction in hospital stay and improvement in neck cosmesis. Minimally invasive surgery has been achieved through advances in surgical techniques such as endoscopic video assisted dissection and robotic surgery using an axillary approach. The advent and implementation of new technologies such as radiological surgical guidance to help localise the pathological glands and the use of intra operative parathyroid hormone assay have also complemented these surgical advances.