Bleeding
If massive intraoperative bleeding occurs, it is first tamponaded and, under continuous suction, an attempt is made to identify the vessel in order to clamp and ligate it.
Intraoperatively undetectable parathyroid adenoma or insufficient intraoperative PTH drop
If, with positive localization diagnostics and focused access, no parathyroid adenoma is shown, an extension of the exploration is indicated first unilaterally then possibly bilaterally. The most common atypical location of the lower parathyroid gland (PTG) is the upper thymus horn.
If 4 normal PTGs could be displayed, it may be the extremely rare case of a supernumerary parathyroid adenoma, possibly abort the procedure and extend the diagnostics.