Complications - Excision of solitary parathyroid adenoma

• Bleeding
• Manage massive intraoperative hemorrhage (e.g., from the Kocher vein or inferior thyroid artery) first by packing, then identify the bleeder under continuous suction, clamp and ligate it.

• Adenoma not identified or inadequate drop in IOPTH level from baseline.
• No altered parathyroids found or no parathyroids found at all→bilateral exploration→extended cervical exploration→ termination of procedure and extended diagnostic work-up.

• Secondary bleeding

Deep secondary bleeding may compress the trachea and vagus nerve, thereby resulting in a life-threatening situation. This mandates stat revision surgery.

• Vocal cord paralysis

Since in most cases vocal cord paralysis results from nerve compression or strain, division of the nerve is less common and the paralysis may resolve. However, bilateral total paralysis of the vocal cords may necessitate tracheotomy.

• Permanent hypoparathyroidism

Life-long substitution of calcium

• Persistent/recurrent PHPT

Extended diagnostic work-up, possibly intraoperative PTH study of the bilateral jugular blood. Possibly PTH selective venous sampling ruling out/confirming a mediastinal parathyroid mass not accessible from the neck.