In a landmark medical achievement, surgeons at Lucknow's Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS) have successfully treated an extremely rare and high-risk bladder tumour using a pioneering ultra-minimally invasive robotic technique. This marks the first reported use of this specific surgical approach for this condition in medical literature.
A Rare and Dangerous Tumour
The patient, a 60-year-old man, was diagnosed with a urinary bladder paraganglioma. This is an exceptionally uncommon functional tumour known for its dangerous tendency to release catecholamines—hormones that can cause sudden, severe spikes in blood pressure—when it is touched or manipulated during surgery. This characteristic makes its surgical removal particularly hazardous.
The man had presented with a set of classic but alarming symptoms, which included recurrent palpitations, episodes of fainting (syncope), severe headaches, and sudden hypertension during urination. These signs pointed to the tumour's active and risky nature.
The Pioneering Surgical Approach
The complex procedure was led by Prof Uday Pratap Singh, professor of urology and renal transplantation at SGPGIMS, along with his team comprising Dr Sanchit Rustagi and Dr Snigdh Garg. They employed a multi-port da Vinci Xi robotic system through a novel transvesical approach.
This innovative method involved accessing and removing the tumour directly from inside the bladder, completely avoiding entry into the abdominal cavity. "By bypassing dissection around the bladder and ureter, we were able to significantly reduce surgical risk while achieving precise tumour removal," explained Prof Singh. The tumour was located perilously close to the right ureter, which heightened the risk of injury with conventional methods.
Advantages Over Traditional Surgery
This robotic technique represents a major leap forward from traditional surgical options for bladder paragangliomas, which typically involve transurethral, open, or laparoscopic approaches. The conventional methods require creating pneumoperitoneum (insufflating the abdomen with gas) and extensive dissection around vital structures behind the bladder.
The new approach eliminated the need for pneumoperitoneum and extensive dissection, leading to:
- Greatly reduced surgical risk.
- Precise removal of the tumour.
- Faster patient recovery.
- Improved overall procedural safety.
The success of this surgery underscores the expanding role of robotic platforms in urology and establishes a new, safer paradigm for managing rare functional tumours of the bladder.
A Team Effort for a High-Risk Case
Given the tumour's potential to cause life-threatening blood pressure fluctuations, the role of the anaesthesia team was critical. The team, led by Prof Sanjay Dhiraj and Prof Amit Rastogi, and including Dr Prakash Chandra and senior resident Dr Shivek, expertly managed extreme intraoperative blood pressure variations to ensure the patient's stability throughout.
The operation was also supported by a skilled operation theatre team, with Manoj Kumar, the robotic OT in-charge, and Liji Joseph, senior nursing officer, playing key roles in the smooth execution of this technically demanding surgery.
Prof Singh concluded that this milestone not only places SGPGIMS on the global map of cutting-edge medical innovation but also offers renewed hope to patients suffering from rare and complex urological conditions across India and beyond.
