Primary hyperparathyroidism caused by a single adenoma is often a simple minimally invasive resection. However, bilateral exploration of the neck can be expected or unexpected while performing parathyroidectomies. Each of the causes of hyperparathyroidism, from the development of single-adenoma or multi-gland disease have similar processes but distinct preoperative work-up, medical, and surgical management, and immediate post-operative surveillance. This expert panel will review the important aspects, nuances, and unique challenges of treating this multifaceted disease process, with particular focus on when and how to do a bilateral exploration with today’s available tools.