Although parathyroid surgery is considered a minor operation and is generally not dangerous, the key to success is finding a surgeon who is very experienced in this procedure. Not surprisingly, higher success rates and lower chances of complications are associated with surgeons who perform parathyroidectomy as a major part of their practice. This is especially true for reoperative parathyroid surgery, where experience is critical for good outcomes.
Many general surgeons out in the community perform only a handful of parathyroid operations each year. These surgeons may be very skilled and have a reasonably good success rate for parathyroidectomy. However, when they encounter a more difficult patient (e.g., a patient with unusual anatomy or multi-gland disease), they do not have extensive experience to draw on and can make critical mistakes. This may simply result in a failure to cure the patient. But, in some cases it may result in accidental removal of all of the parathyroid glands (permanent hypoparathyroidism) or injury to the recurrent laryngeal nerves with changes in the voice.
Just because your endocrinologist refers you to a local surgeon does not mean that the surgeon is a high-volume, experienced parathyroid surgeon. We strongly suggest that you do your homework and find the most experienced endocrine surgeons in your area. This may be accomplished by word of mouth, or you may find the answers you’re looking for online. Once you meet with a surgeon, ask him or her how many thyroid and parathyroid operations they do each year and how many total operations they have done since they finished training. A good rule of thumb is to find someone who performs at least 50 parathyroid operations per year or 150-200 thyroid or parathyroid operations per year. There is considerable overlap between thyroid and parathyroid surgery in terms of the anatomy and operative techniques. Another way to judge an experienced parathyroid surgeon is to find someone who has performed >500 thyroid or parathyroid operations since they finished their training.