The Department of Endocrine Surgery at SGPGIMS was the first of its
kind it India, when it was first established in 1989. Since then it has
contributed immensely in the management of complex endocrine disorders
and also contributed to the training of many young endocrine surgeons.
Prof. S.K. Mishra
Dr. A.K. Verma
Dr. Amit Agarwal
Dr. Gaurav Agarwal
Dr. Anjali Mishra
Dr Gyan Chand
Endocrine surgeons are the surgeons who have special expertise in operations
on certain organs which may rarely be encountered by other type of surgeons.
Surgery of the thyroid gland is indicated if there is a thyroid nodule
/ enlargement that may be concerous, or if there is over activity (thyrotoxicosis).
The department specializes in performing total thyroidectomy (removal of
entire gland) with minimal complications. Another important aspect of thyroidectomy
being performed at this institution is minimal / small incision thyroidectomy
with less postoperative pain, good cosmesis, and less hospital stay.
Parathyroid glands are 4 in no. and are located near the back surface
of the thyroid gland. They produce parathyroid hormone (PTH) which regulates
the level of calcium in the blood. When one or more of these glands enlarge
& become hyperactive, calcium in mobilized from the bones. In such
a situation, bones become weak, fracture easily and blood calcium level
Surgery provides a permanent cure of this condition.
The department specializes in performing minimally invasive or focused
parathyroid surgery whereby the enlarged parathyroid gland is removed by
a small 1.5-2 cm incision resulting in excellent cosmesis, less pain, less
Adrenal Gland Surgery
Adrenal glands are small glands located on the top of each kidney.
Adrenal glands are responsible for hormone production such aldosterone,
catecholamines (adrenaline), steroids and some sex hormones
When is Adrenal Surgery needed: Surgical removal of adrenal gland is
called adrenalectomy and may be indicated in situations of excess hormone
production or if a malignancy (cancer) is suspected.
The department at SGPGIMS specializes in performing laparoscopic removal
of the adrenal gland which involves removal of the entire adrenal gland
/ adrenal tumor through the use of small incisions. Patients have less
pain and more rapid and early recovery.
The department in close collaboration of department of Endocrinology
and Anesthesia. Specializes in management of pheochromocytomas (a type
of tumor) which may overproduce adrenaline and other hormones which can
cause very high blood pressure, heart problems, headache.
Endocrine Pancreatic Surgery
The pancreas is a complex organ located in the abdomen. Besides other
cells, its has endocrine cells (islet cells) which produces many hormones
including insulin which intern regulated the blood sugar level. If a tumor
of these islet cells occurs it may overproduce one or more of these hormones,
most important of which is insulin and the resulting tumor is called insulinoma.
Such a patient has a problem of low blood sugar (hypoglycemia) and suffers
from headache and fainting attacks. Endocrine pancreatic surgery is recommended
for removal of these tumors, most of which are very small. Many of there
endocrine tumors may be dissected out of the substance of the pancreas,
but in some cases may require partial removal of the pancreas (pancreatectomy)
Thymectomy for Myasthenia Graves
Thymus is a H-shaped gland located in the chest, behind the breast bone
(sternum). It is usually enlarged or tumors in a condition called. Myasthenia
Gravis. This is a disease is which there occurs weakness of muscles and
later difficulty in eating, --- and breathing. It is now well established
that removal of this gland (the operation is called THYMECTOMY) results
in improvement of symptoms in 80% cases with complete relief in 30%
patients thymectomy usually involves removing the gland by cutting the
chest bone (sternum). The department also specializes in removing the gland
through thoracoscopic procedure (VATS) which involves removal of gland
via 3-4 small incision while the chest bone is not cut. This results in
early & rapid recovery of the patient.
The department also manages the breast diseases as then is no separate
oncology department in SGPGIMS. The departmental handles both benign breast
diseases and carcinoma breast as well.
Carcinoma Breast: Management of breast cancer involves surgery
(mastectomy or removal of breast), radiotherapy and chemotherapy.
Mastectomy: Breast cancer cases which present early can opt for breast
conservative surgery whereby only the cancerus portion along with some
normal time and glands in the armpit are removed and the breast can be
preserved with reasonable patients who have advanced disease would require
total removal of breast and glands in the armpit.
Chemotherapy: is required in 3 settings:
1. Adjuvant chemotherapy: In patients who have positive glands in the
axilla (armpit) usually a combination of 3 drugs oreguin
2. Neoadjuvant chemotherapy: In patients who have locally advanced
breast cancer, 3 cycles of chemotherapy are given prior to surgery to downstage
the tumor. This helps in delaying / preventing the local recurrence / distant
3. Metastatic disease: In patients whom the disease has spread to distant
organs (lungs, liver, bones) chemotherapy is given primarily.
Sentinel Node Biopsy
This is a new tool whereby only one or two glands (lymph nodes) are
excised from the axilla. If it is positive on histology (frozen section)
only then a full axillary dissection is performed. Those patients in whom
it is negative are saved from the complications (hyperes--, numbness) of
full axillary dissection, currently the department is running a trial of
sentinel lymph node biopsy.
1. Mishra A, Agarwal G, Agarwal A, Mishra SK. Safety and Efficacy of
Total thyroidectomy in hands of Endocrine Surgery Trainees. Am J Surg 1999;
178(5): 377- 380.
2. Batra V, R Khadgawat, Agarwal A, Krishnani N., et al. Correlation
of cell counts and indices in FNAC Testis with testicular histology in
male infertility. Acta Cytologica 1999; 43: 617-623.
3. Agarwal S, Dutta NR, Mishra SK, Kumar S, Tandon V, Ayyagiri S, Agarwal
A. Adjuvant Therapy in invasive thymoma: An audit of cases treated over
an 8 year period. Indian J Cancer 1999; 35:45-46.
1. Agarwal A, Agarwal G, Mishra SK. Thyroid surgery and recurrent laryngeal
nerve : A letter to editor. Br J Surg 1999; 86: 1479
1. Misra AK, Mishra A, Agarwal A, Agarwal G, Mishra SK. Occult breast
cancer- a management dilemma. Annals of Endocrine Surgery (official journal
of Indian Association of Endocrine Surgeons). 1999; 3: 10-13.
2. Agarwal G, Mishra A, Kar DK, Agarwal A, Mishra SK. Current status
of parathyroid transplantation. Hospital Today 1999: IV(4): 182
3. Agarwal A, Mishra AK, Mishra A, Kar DK, Agarwal G, Mishra SK. Intra-operative
diagnostic studies in endocrine surgery. Hospital Today 1999: IV(3): 146.
Abstracts published in Indexed Journals:
1. Mishra AK, Mishra A, Agarwal G, et al. Adrenal tumours in children
(Abstract) Journal of Japan Surgical Society, vol. 100, no. 1, p 193, 1999.
2. Agarwal A, Mishra SK, Funahashi H, Mithal A, Godbole MM, Baijal
SS, Krishnani N, Imai T. Cytological and ultrasonographic characterization
of nodular goiters in an endemic goiter area: result of a field study.
(Abstract) Journal of Japan Surgical Society, vol. 100, no. 1, 1999
3. Mishra A, Agarwal G, Agarwal A, Mishra SK. Safety and Efficacy of
total thyroidectomy in hands of trainees. (Abstract) Journal of Japan Surgical
Society, vol. 100, no. 1, p 163, 1999.
4. Kar DK, Mishra A, Agarwal A, Agarwal G, Mishra SK. Surgical treatment
of Grave’s disease. (Abstract) Journal of Japan Surgical Society, vol.
100, no. 1, p 163, 1999.
5. Agarwal G, Mishra SK, Mithal A, Arya, V. Remarkable but disorderly
recovery of osteitits fibrosa cystica following parathyroidectomy. (Abstract)
Journal of Japan Surgical Society, vol. 100, no. 1, p 164, 1999.
1. Parathyroid gland weight and skeletal disease in primary hyperparathyroidism:
influence of Vitamin-D nutrition. International symposium on thyroid and
parathyroid tumors, Pisa, Italy, 1999.
2. Aggressive thyroid cancer in low risk age group: International symposium
on thyroid and parathyroid tumors, Pisa, Italy, 1999.
3. 38th World Congress of Surgery of the International Society of Surgery,
August 15-20, 1999, Vienna, Austria.
4. Endocrine tumors of pancreas. At symposium on "Pancreatic disease-
Controversies and Challenges", 1999 Chandigarh.
5. Pancreas transplantation - Introduction and screening of a Video
film on surgical technique. Sept. 13th , 1999, Seminar all, Dept. of Surgery,
Manipal Medical College, Manipal, INDIA.
6. Endocrine Surgery Update, Cuttack, October, 2000.
7. 38th World Congress of Surgery of the International Society of Surgery,
August 15-20, 1999, Vienna, Austria.
8. Total thyroidectomy for the Benign Thyroid Disease, 100 Annual meeting
of Japanese Surgical Society.
9. Management of pheochromocytoma: experience from a referral center.
Annual conference of Indian Association of Surgical Oncology, Dehradun,
10. Primary hyperparathyroidism in Indians: some unique observations
(on pathogenesis and radiologic and densitometric recovery of osteitis
fibrosa cystica). At the European Institute of Tele-surgery and Hospital
Civil, University of Strasbourg, France, 1999.
11. Post-operative management of advanced skeletal disease in primary
hyperparathyroidism. At 4th PGES and International workshop of Endocrine
Tele-surgery, Lucknow, 1999.
12. Endocrine Imaging. At 4th PGES, Lucknow, 1999.
13. Marked but disorderly recovery of osteitis fibrosa cystica following
parathyroidectomy in patients with PHPT. 99th annual congress of Japan
Surgical Society, Fukuoka, Japan, 1999.
14. Metastatic differentiated thyroid carcinoma (DTC): experience in
endemic area. 7th Congress of Asian Association of Endocrine Surgeons,
Adelaide, Australia, 2000.
15. Recent advances in Endocrine Surgery at Foundation Day of Department
of Surgery, KGMC, Lucknow, 2000.
16. Multiple Endocrinopathy, Surgery Update, Maulana Azad Medical College,
New Delhi 2000.
17. What specialist will do "Breast Cancer" North Zone Chapter ASI,
PGI, Chandigarh. 2000
18. Re- operative parathyroid surgery. ASI, New Delhi 2000.
19. Epidemiology of multinodular goiter. ASI, New Delhi 2000.
20. Multiple Endocrinopathy, Surgery Update 2000, Maulana Azad Medical
College, New Delhi.
21. What specialist will do "Breast Cancer" North Zone Chapter ASI,
PGI, Chandigarh. 2000.
22. Increased and abnormal expression of human sodium iodide symporter
gene in breast cancer tissue. International conference on "Breast cancer
in the new millennium", Nagpur, 2000. AWARDED BEST BASIC RESEARCH PAPER
23. XV Asia Pacific Cancer Conference, Chennai: Co-existence of thyroid
carcinoma in hyperthyroid patients- M Baxi, Agarwal A, Agarwal G, SK Mishra
24. 99th Annual Conference of Japanese Surgical Society, Japan: Surgical
treatment of Graves disease: DK Kar, A Mishra, Agarwal A, Agarwal G, SK
25. 99th Annual Conference of Japanese Surgical Society, Japan: Safety
and efficacy of total thyroidectomy in hands of trainees: A Mishra, Agarwal
G, Agarwal A, Mishra SK
26. 99th Annual Conference of Japanese Surgical Society, Japan: Adrenal
tumors in children: AK Mishra, Mishra A, Agarwal G, Agarwal A, Mishra SK
27. 99th Annual Conference of Japanese Surgical Society, Japan: Management
of invasive thymomatous myasthenia gravis: M Baxi, DK Kar, Agarwal A, Agarwal
G, Mishra SK
28. 99TH Annual Conference of Association of Surgeons of India, Madurai:
Differentiated thyroid cancer in the Young: Aggressive behaviour in endemic
region- A Mishra , A Agarwal , G Agarwal, SK Mishra
29. 99TH Annual Conference of Association of Surgeons of India, Madurai:
Clinico-Investigative profile and therapeutic outcome of adrenal Cushings
Syndrome: DD Samant, A Mishra, G Agarwal, A Agarwal, SK Mishra
30. 99TH Annual Conference of Association of Surgeons of India, Madurai:
Adrenal tumors in children: An institutional experience- AK Mishra, A Mishra,
G Agarwal, A Agarwal, SK Mishra
31. Annual Conference of Indian Association of Surgical Oncology: Mediastinal
Imaging in Myasthenia Gravis: Clinico-pathological correlation: DK Kar,
Agarwal A, SK Mishra , G Agarwal, V Sawlani, M Baxi.
32. CME Pancreas- PGI Chandigarh: IOUS in surgery for insulinoma: A
vital tool in decision making: AK Mishra, A Agarwal, G Agarwal,
33. Surgery Update- Command Hospital, Lucknow: Surgical treatment of
graves disease: AK Mishra, A Agarwal, G Agarwal, SK Mishra
34. Surgery Update- Command Hospital, Lucknow: Adrenal tumors in children:
An institutional experience: R Agarwal, AK Mishra, A Mishra, G Agarwal,
A Agarwal, SK Mishra
35. Surgery Update- Command Hospital, Lucknow: IOUS in surgical treatment
of Insulinoma: DD Samant, A Agarwal, SK Mishra, A Mithal, G Agarwal, E
36. Surgery Update- Command Hospital, Lucknow: Parotid tumors: Surgical
management: DK Kar, AK Mishra, A Mishra, A Agarwal, G Agarwal, SK Mishra
Research Projects (Intramural / Extramural)
Dr. S.K. Mishra
- Ongoing - Two
Name of the Project-
1. P53 mutation status and micro-vessel density in Well - Differentiated
thyroid carcinoma. Intramural
Dr. Amit Agarwal
Ongoing - Two
Name of the Project-
1. Phospholipase C: Predictor of thyroid carcinoma aggressiveness.
2. Study of risk factors in development of hypocalceamia following
Principal Investigator Dr. Amit
Funding (intramural / Extramural ) Intramural
Dr. Gaurav Agarwal
- Ongoing - Two
1. Name of the Project: “Study of biochemical markers of bone turnover
in metastatic and non-metastatic breast cancer”.
2. Name of the Project: “Study of effects of iodine adjunct treatment
on gene expression of molecules involved in iodine transport (NIS) and
apoptotic effector pathway (bcl-2, bcl-xl and bax) in DMBA induced breast
cancer in rats.”.
Principal Investigator Dr. Gaurav Agarwal
Funding (intramural / Extramural ) Intramural
Alumni & Address:
The department runs OPD services for 5 days in a week
There is one OT dedicated to Endocrine Surgery --- which is functional
round the clock.
The Endocrine Surgery Ward Block has 30 beds.
Treatment is offered for diseases of following organs/system
-Pancreatic endocrine tumors
-Thymus (Thymectomy for Myasthenia Gravis)
-Minimal Invasive Surgery in Endocrine Surgery
The department comes out estimation of
1. Urinary iodine
2. Serum thyroglobulin for management of Carcinoma thyroid.
The department has an elaborate trading program with daily morning services
(8-9AM which includes journal clubs, seminars, case discussions, joint
conferences with Endocrinology, Radiology, Radiotherapy, Genetics, Nuclear
The department has been running a PDCC in Endocrine surgery for last
8 years and has recently started a 3 years M.Ch course in Endocrine Surgery.
The department also encourages short term training for surgeons to develop
the specialty of Endocrine Surgery at their respective centers
CMEs / Workshops
The department runs a CME program -Post Graduate Course in Endocrine
Surgery every two years Following PG Courses have been organized
• 6th Post Graduate Course in Endocrine Surgery and 4th International
Workshop on Minimally Invasive Endocrine Surgery, October, 2003.
• 5th Post Graduate Course in Endocrine Surgery and International Workshop
in Endocrine Tele-surgery, Lucknow, February, 2002.
• Workshop on Minimally Invasive Endocrine Surgery, Lucknow, October,
• 1st National Symposium on Endocrine Imaging and Tele-radiology, Lucknow,
23-24 Sept, 2000
• Indo-US Symposium and slide seminar on Endocrine Surgical Pathology,
Lucknow 26-27 Feb., 2000
• 4th Post Graduate Course in Endocrine Surgery and International Workshop
in Endocrine Tele-surgery, Lucknow, 25-29 October, 1999.
• Regional Workshop on Video-Assisted Thoracoscopic Thymectomy for
Myasthenia Gravis, 1999
• 4th Annual Conference of Indian Association of Endocrine Surgeons,
SGPGIMS, Lucknow, 1997.
• 3rd Postgraduate Course in Endocrine Surgery and Indo-Japanese Workshop
on Thyroid Cancer, SGPGIMS, Lucknow, 1997.
• Indo-Japanese Workshop on Parathyroid Surgery and 2nd Postgraduate
Course in Endocrine Surgery, SGPGIMS, Lucknow, 1996.
• 1st Post Graduate Course in Endocrine Surgery, SGPGIMS, Lucknow,