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Bilateral neck exploration is the standard procedure in primary hyperparathyroidism. Using a bilateral approach, preoperative localization studies are not mandatory. A localized single gland disease is the basis for a minimally invasive procedure. Therefore preoperative localization techniques play an important role in planning (minimally invasive) first time exploration for primary hyperparathyroidism. The combination of (99 m)Tc-SestaMIBI scintigraphy with ultrasound allows correct localization of the parathyroid adenoma in 86 % of all single gland diseases. Multiple gland disease could be predicted in isolated cases only. Computerized tomography and magnetic resonance imaging could not improve the results. Surgery for persistent or recurrent hyperparathyroidism should only be performed after positive localization studies.
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