•                            Department of Endocrine Surgery
    •  

      About Us

      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.

      Faculty

      Prof. S.K. Mishra
      Dr. A.K. Verma
      Dr. Amit Agarwal
      Dr. Gaurav Agarwal
      Dr. Anjali Mishra
      Dr Gyan Chand

      Procedures:
      Endocrine surgeons are the surgeons who have special expertise in operations on certain organs which may rarely be encountered by other type of surgeons.

      Thyroid Surgery: 
      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 surgery:
      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 rises.

      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 postoperative stay.
      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. 

      Breast Surgery
      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 metastases.
      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. 

      Departmental Publications 

      Original Articles:
      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.

      Letters/ Correspondence: 
      1. Agarwal A, Agarwal G, Mishra SK. Thyroid surgery and recurrent laryngeal nerve : A letter to editor. Br J Surg 1999; 86: 1479

      Review Articles:
      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.

      Presentations:

      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, 1999.
      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 AWARD.
      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 Mishra
      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,    SK Mishra
      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 Bhatia
      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
      Projects detail:  
      Name of the Project-
      1. P53 mutation status and micro-vessel density in Well - Differentiated thyroid carcinoma.     Intramural
      Dr. Amit Agarwal
      Ongoing - Two
      Projects detail:  
      Name of the Project-
      1.  Phospholipase C: Predictor of thyroid carcinoma aggressiveness.
      2. Study of risk factors in development of hypocalceamia following thyroid surgery.
       Principal Investigator      Dr. Amit Agarwal
      Funding (intramural / Extramural )   Intramural

      Dr. Gaurav Agarwal 
      - Ongoing - Two
      Projects detail
      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:

      Infrastructure Available:
      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.

      Clinical Services:

      Treatment is offered for diseases of following organs/system

      -Thyroid
      -Parathyroid
      -Adrenal
      -Pancreatic endocrine tumors
      -Breast
      -Thymus (Thymectomy for Myasthenia Gravis)
      -Diabetic Foot
      -Minimal Invasive Surgery in Endocrine Surgery

      Laboratory Services

      The department comes out estimation of 
      1. Urinary iodine
      2. Serum thyroglobulin for management of Carcinoma thyroid.
       
      Teaching Activities

      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 Medicine 

      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 till date:-

      • 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, 2000
      • 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, 1993.
       
       
       


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