Inaya’s (name changed) life began not with celebration, but with a race against time. Weighing just 4.6 kg, the one-month-old infant successfully underwent life-saving robotic pancreatic surgery at Manipal Hospital Whitefield—a rare and remarkable medical feat marking one of the youngest cases of its kind in the world.
The infant was diagnosed with congenital hyperinsulinism just 16 days after birth.
What is congenital hyperinsulinism?
Congenital Hyperinsulinism is a life-threatening condition in which the pancreas produces excessive insulin, causing dangerously low blood sugar levels.
Each hypoglycaemic episode posed a silent but serious threat of irreversible brain damage.
Dr Kavitha Bhat, Consultant – Pediatric Endocrinology at Manipal Hospital Whitefield, said that her condition was deteriorating despite receiving the highest concentrations of intravenous glucose. "Her blood sugar levels continued to fall to critical levels," she said.
"In newborns, the brain depends almost entirely on sugar for energy. When blood sugar falls repeatedly, the brain doesn’t get enough fuel, which can cause permanent damage affecting learning, movement, and development. This damage is often silent and cannot be reversed," said Dr Bhat.
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After a series of diagnostic tests—including a specialised 18F-DOPA PET/CT scan—doctors pinpointed the exact cause of the issue and recommended surgical intervention.
According to Dr Bhat, focal congenital hyperinsulinism can be potentially cured with surgery. "The scan revealed a tiny 0.5 cm lesion in the pancreas—no larger than a pea—pinpointing the exact source of excessive insulin production," she said.
Unlike diffuse disease, focal hyperinsulinism allows surgeons to remove only the affected portion of the pancreas, preserving normal function and eliminating the need for lifelong medication or insulin therapy.
Next, the big challenge for the doctors was the surgical approach.
While conventional open surgery remained an option, it carried higher risks in such a small infant, including removal of excess pancreatic tissue, future diabetes, and digestive complications. Therefore, the team opted for a robotic-assisted approach.
The surgery was led by Dr Manjunath Haridas, Consultant – Colorectal, GI & Robotic Surgery, along with Dr Arvind Sabharwal, Consultant – Pediatric Surgery, supported by multidisciplinary teams from Pediatric Endocrinology, Neonatal Intensive Care (NICU), and Anaesthesia.
The surgery was completed without complications or blood loss. The baby’s blood sugar levels stabilised immediately, eliminating the need for further glucose infusion.
“There are very few reports of robotic pancreatic surgery in infants, and none of robotic pancreatic surgery in a one-month-old child. The achievement reflects what is possible when technology, expertise, and teamwork come together for the smallest and most vulnerable patients," Dr Haridas said.
After the procedure, baby Inaya was closely monitored in the NICU for nine days and showed excellent recovery. She was discharged on oral feeds with minimal medication and no ongoing need for intensive glucose management.