Excision of solitary parathyroid adenoma

Incise the skin 2 finger widths (2-3 cm) superior to the suprasternal notch between the bellies of the left and right sternocleidomastoid muscles (so-called Kocher or collar incision). Divide the platysma with electrocautery.

Note: In single parathyroid adenomas with well-known location the skin incision may be much smaller than, e.g., in thyroidectomy.

Divide the subcutaneous tissue and enter the white line of the neck. Between forceps divide and ligate any superficial jugular veins in the cervical fascia.

Tip: Simple ligatures of the cervical veins often slip off during surgery. Closure is best accomplished by suture-ligation (PDS 3/0).

Retract the strap muscles of the neck from the anterior aspect of the thyroid. Expose both thyroid lobes circumferentially, expose the trachea and divide any superficial vessels encountered.