Parathyroid surgery has always been considered difficult as many surgeons do not feel confident that they can reliably find the parathyroid glands. To gain the required skill level detailed understanding of the developmental embryology, anatomy, and endocrinology as well as good understanding of calcium metabolism. A meticulous and skilled technique is required to perform the almost bloodless operation needed to find parathyroid glands. A failed primary operation leads to a very difficult second operation associated with a significant potential for complications and failure. The following significant changes in parathyroid surgery have occurred in the last decade: (1) Minimally invasive parathyroidectomy (MIP): MIP has become the operation of choice for primary hyperparathyroidism (1HPT) where a single gland has been identified by surgeon performed ultrasound (SPU) and/or sestamibi (SM). This occurs in around 80% of cases. However, as any one who teaches MIP knows it is the knowledge and experience that comes from bilateral neck exploration (BNE) in the remaining 20% that determines the success of MIP. Also, recurrent or persisting disease may be amenable to a minimally invasive ap
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