WHITE CAP: Intra-operative Parathyroid Tissue Sensor (PTS)-Guided Assessment of Parathyroid Viability and Surgical Decision-Making

Primary hyperparathyroidism is usually cured by removing the single over-active parathyroid adenoma. During surgery, however, surgeons often see a thin rim of normal parathyroid tissue that still "glows" under a near-infrared parathyroid tissue sensor (PTS). It is unclear whether keeping this tissue in place helps preserve hormone function or whether it leaves behind cells that could become over-active again. The WHITE CAP study will compare two common surgical choices: Preservation strategy - the surgeon removes only the adenoma and leaves the glowing rim of normal tissue untouched. En-bloc strategy - the surgeon removes the adenoma together with the glowing rim; if too little parathyroid tissue remains, a small fragment is transplanted into the forearm muscle. About 120 adult patients who have a single parathyroid adenoma will be randomly assigned (like tossing a coin) to one of the two strategies. All operations will use the same FDA-cleared PTS camera that shows the glands in real time without dye or radiation. The main question is whether preserving the normal rim lowers the rate of temporary low blood-calcium (numbness, tingling) during the first two days after surgery. The study will also check long-term results-blood calcium and parathyroid hormone (PTH) levels, symptoms, and any return of the disease-over two years. The PTS imaging itself is painless and adds only a few minutes to the operation. Risks are the same as for standard parathyroid surgery, and participants can withdraw at any time without affecting their usual care.

Sex

All

Minimum age

18 Years

Maximum age

75 Years

Inclusion Criteria:

* Age 18 to 75 years, able to give informed consent.
* Biochemically proven primary hyperparathyroidism (elevated serum calcium and inappropriately high PTH).
* Pre-operative imaging (sestamibi scan, 4-phase CT, or ultrasound) concordant with a single parathyroid adenoma.
* Planned minimally invasive parathyroidectomy using near-infrared parathyroid tissue sensor (PTS) guidance.

Exclusion Criteria:

* Multiple endocrine neoplasia (MEN 1 or 2) or suspicion of multi-gland disease (\>1 enlarged gland on imaging).
* Prior parathyroid or extensive neck surgery causing distorted anatomy.
* Need for simultaneous total thyroidectomy or other major neck procedure.
* Estimated glomerular filtration rate (eGFR) \< 30 mL/min/1.73 m².
* Pregnancy or breastfeeding.
* Inability to tolerate general anaesthesia or contraindication to intra-operative PTS imaging.