3 The procedure
3.1 Minimally invasive video‑assisted parathyroidectomy is usually done with the patient under general anaesthesia. A small incision is made above the sternal notch. This allows for bilateral neck exploration. An endoscope is inserted through the incision and dissection of the parathyroid gland(s) is carried out. The operative space is maintained using external retraction: gas insufflation is not used. Care is taken to identify and preserve the recurrent laryngeal nerve. Typically, an assay is used to monitor parathyroid hormone levels during the operation.
3.2 An alternative technique uses a lateral approach via an incision at the anterior border of the sternocleidomastoid muscle. A space is dissected between the ipsilateral thyroid lobe, the carotid artery and the internal jugular vein to allow insertion of an endoscope.