- Patient positioned supine with neck extended, slight head elevation
- Small transverse cervical incision (approximately 2–3 cm) made over the localized gland
- Platysma divided, subplatysmal flaps raised
- SCM identified and retracted laterally
- Dissection taken on the lateral border of the Strap muscles as they are retracted medially
- Dissection down to identify the carotid sheath and the thyroid
- Middle thyroid vein may need to be ligated
- Localize the abnormal gland using preoperative imaging guidance and intraoperative cues
- Careful dissection of the parathyroid gland preserving surrounding structures (recurrent laryngeal nerve, thyroid)
- Intraoperative PTH monitoring may be used to confirm adequacy of resection (expect >50% drop at 10 minutes)
- Hemostasis achieved
- Wound closed in layers