Several controversies regarding surgical treatment of disease are discussed in this issue. The first concerns the approach to patients with primary hyperparathyroidism. There appears to be a good deal of pressure to perform preoperative localization with sestamibi scanning, focused unilateral minimally invasive operations, and intraoperative parathyroid hormone analysis. Lee and NortonArticle present a literature review of 2095 patients operated on with a focused unilateral approach that yielded 92.5% of patients with a single adenoma and 5.3% with multiple adenomas, whereas of 2166 patients who underwent bilateral neck exploration, 19.3% had multiple-gland disease. In their own series of bilateral open-neck exploration, 20.6% of patients had multiple-gland disease. The best explanation of this discrepancy appears to be selection, with an alternative being the function of the second- and third-gland disease. As part of this discussion, please review the cost-benefit analysis by Fahy et alArticle, indicating that limited parathyroid surgery using any localizing strategy is cost-effective, safe, and efficacious in the management of primary hyperparathyroid disease.