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Sackett et al¹ are to be congratulated on their timely survey of minimally invasive techniques currently used by endocrine surgeons worldwide for parathyroidectomy. Indeed, parathyroidectomy has been fast evolving, as evidenced by a plethora of landmark articles in the past decade.² Sackett et al state that the 3 "earliest reports" of minimally invasive parathyroidectomy (MIP) described the use of a true endoscopic technique. Notably, the first 2 references were duplicated reports of the same case, and the third reference was published in 1999. I described the totally endoscopic technique and its results as early as 1997 and 1998.² However, after a brief period of enthusiastic application, I shifted to a nonendoscopic direct approach via a mini-incision in a neck wrinkle because most patients were elderly. The endoscopic approach is now reserved for those few young patients with a superior parathyroid gland deeply located around the upper pole of the thyroid, . . . [Full Text of this Article]

W. T. Ng, FRCS
Tsuen Wan, Hong Kong