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Title
1. Introduction
2. Incision
3. Exposure of Thyroid Gland and Overlying Strap Muscles
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a. Subplatysmal Flaps
b. Separate Strap Muscles
4. Exposing and Exploring all Four Parathyroid Glands
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a. Left Inferior Parathyroid with Removal: Most Suspicious on Pre-op Imaging
b. Left Superior Parathyroid
c. Right Inferior Parathyroid
d. Right Superior Parathyroid
e. Summary of Findings
f. Further Exploration of Left Superior Parathyroid
g. Re-evaluation and Preservation of Right Inferior Parathyroid
h. Re-evaluation and Removal of Right Superior Parathyroid
i. Summary of Progress and Comparison with Expectations from Pre-op Imaging
j. Return to Right Inferior Parathyroid Gland for Biopsy
5. PTH Check and Hemostasis with Surgicel
6. Closure and PTH Check
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a. Sternohyoid Muscle with 4-0 Vicryl Interrupted Sutures
b. Platysma with 4-0 Vicryl Interrupted Sutures
c. Skin with Running, Knotless 5-0 Monocryl Subcuticular Suture and Steri-Strips
7. Post-op Remarks
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Parathyroidectomy and Four-Gland Exploration for Hyperparathyroidism
Allison S. Letica-Kriegel, MD, MSc
;
Antonia E. Stephen, MD
Massachusetts General Hospital
Tags:
General Surgery
Main Text
Procedure Outline
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Authors
Allison S. Letica-Kriegel, MD, MSc
Antonia E. Stephen, MD
Filmed At:
Massachusetts General Hospital
Article Information
Publication Date
11/21/2025
Article ID
463
Production ID
0463
Volume
2025
Issue
463
DOI
https://doi.org/10.24296/jomi/463