Although this is not the first study indicating that one can, under appropriate circumstances, perform directed parathyroidectomy, this article by Burkey et al reviewed 100 consecutive patients with untreated, sporadic primary hyperparathyroidism. Following preoperative imaging (sestamibi scintigraphy and ultrasonography), patients underwent parathyroidectomy with intraoperative parathyroid hormone monitoring through either a limited neck incision or bilaterally through a standard collar incision. In 70 of these individuals, a limited incision was possible, with excellent results and shorter operative time and length of hospital stay. All patients were eucalcemic postoperatively. The authors present an algorithm for your perusal.