Secondary hyperparathyroidism (SHPT) is a common complication in patients with chronic kidney disease who underwent long-term dialysis, significantly increasing mortality risk and impairing quality of life. Current treatment options include vitamin D supplements and calcimimetics, with parathyroidectomy recommended when pharmacological therapy is ineffective. The main surgical approaches consist total parathyroidectomy, subtotal parathyroidectomy, and total parathyroidectomy with autotransplantation. Each technique focuses on different clinical objectives and presents distinct advantages and limitations. Total parathyroidectomy is considered effective in reducing postoperative recurrence rates and the need for reoperation, yet its safety and associated complications remain subjects of ongoing debate. This review aims to examine the current application of total parathyroidectomy in the management of SHPT and to analyze future trends in its use.