A 44-year-old male driver has been undergoing regular hemodialysis for end-stage renal disease (ESRD) and secondary hyperparathyroidism for the past 5 years. Medical treatment with medications like calcitriol, sevelamer, and cinacalcet has failed to control his high parathyroid hormone (PTH) levels. Pre-operative labs show elevated serum calcium, phosphorus, and PTH. Consultations found him to be in stable cardiac and ENT condition. The decision was made to perform parathyroidectomy surgery given the failure of medical management of his tertiary hyperparathyroidism in the setting of ESRD.