Introduction Primary hyperparathyroidism (pHPT) is characterised by symptomatic hypercalcaemia with high parathyroid hormone (PTH) levels in the absence of secondary or tertiary causes. Bilateral cervical exploration with the identification of the parathyroid glands and the removal of a hyperfunctioning adenoma is the main treatment. 1 Most patients with pHPT have a solitary adenoma and these patients are usually cured when this hyperactive gland is removed. Performing a safe and effective anaesthesia for parathyroid surgery under hypercalcaemic conditions can become a problem for anaesthesiologists. 2,3 This condition can be dangerous with comorbid diseases including those of the cardiovascular and respiratory systems. Local anaesthetic techniques are safer than general anaesthesia (GA) in these high risk groups. 3 In recent years, preoperative and perioperative localization techniques for parathyroid adenomas have been developed and, for this reason, minimally invasive parathyroidectomies (MIPs), such as video-assisted endoscopic and mini incision parathyroidectomies, have been frequently applied. Preoperative 99m Tc sesta MIBI scintigraphy, intraoperative radio-guided parathyroidectomy, selective use of intraoperative frozen tissue examinations and intraoperative PTH assays play a major role in MIPs. 4-8 MIPs have lower surgical and anaesthetic complication rates, with a reduced hospitalization time and cost compared with conventional parathyroidectomies. Additionally, one advantage of this method is the high success rate that varies from 95-100%. 9 The process used for the MIP intraoperative radio guided parathyroidectomy is expensive and time consuming; moreover, it requires skilled and trained personnel. Procedures are needed that are inexpensive, simpler and require less personnel for MIP. Therefore, we aimed to investigate the benefits of an ultrasound assisted guided wire localization method that is more simple and inexpensive. We aimed to investigate the benefits of ultrasound-assisted guided wire localization in MIP for selected cases. Methods Prospective nonrandomised patients (n=36) underwent MIP between March 2013 and November 2014 in Canakkale Onsekiz Mart University Faculty of J Pak Med Assoc 1427 ORIGINAL ARTICLE A new technique to simplify the minimally invasive parathyroidectomy: Ultrasound-assisted guided wire localization for solitary parathyroid adenomas Faruk Ozkul, 1 Muhammed Kasim Arik, 2 Mustafa Eroglu, 3 Umut Faydaci, 4 Huseyin Toman, 5 Sukru Tas, 6 Kubilay Ukinc, 7 Mehmet Asik 8 Abstract Objective: To investigate the benefits of ultrasound-assisted guided wire localization in MIP for selected cases. Methods: In this prospective, nonrandomised study, we included 36 patients with solitary parathyroid adenomas diagnosed preoperatively by 99m Tc sesta MIBI scintigraphy and/or neck ultrasonography. An ultrasound-guided wire was placed in the solitary parathyroid adenoma preoperatively. MIPs were performed under local anaesthesia plus sedation. After the excision, the parathyroidectomy was confirmed with postoperative ultrasonography. Results: There were 36 patients included in our study. The mean age was 54.89±11.28 years, and 30 patients were females (83.3%). Preoperative PTH and calcium (Ca) levels were 269.5 pg/mL (83.5-5,000 pg/mL) and 12.2 mg/dL (11.1-20 mg/dL), respectively. Postoperative serum PTH and Ca levels were 42.04±26.65 pg/mL and 8.95±0.74 mg/dL, respectively. The mean operation time was 21.69±6.4 minutes and the average hospitalisation time was 18 hours (range: 10-72 hours). Conclusions: Ultrasound-assisted guided wire localization may be useful in selected MIP cases. The MIP advantages include higher success rates and being easy to learn and practise. Keywords: parathyroid neoplasms, Minimally invasive surgical procedures, Parathyroidectomy, Monitoring, Intraoperative, Ultrasonography. (JPMA 66: 1427; 2016) 1,6 Departments of General Surgery, 2 Departments of General Surgery, Faculty of Medicine, 3,7,8 Departments of Endocrinology and Metabolism, Faculty of Medicine, 5 Anesthesia and Reanimation, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, 4 Departments of General Surgery, Yakindogu University, Northern Cyprus,Turkey. Correspondence: Mustafa Eroglu. Email: drmustafaeroglu@hotmail.com