Insulinomas are rare and elusive pancreatic tumours that frequently evade routine diagnostic scans Measuring just 1.3 cm and situated at the neck of the pancreas, the tumour’s location added significant surgical complexity.

Kauvery Hospital, Vadapalani, successfully diagnosed a rare and elusive pancreatic tumour known as an insulinoma in a 60-year-old woman, causing persistently low blood sugar and frequent loss of consciousness.

Kauvery Hospital, Vadapalani

The hospital followed a stepwise diagnostic approach. Initial imaging studies, including a contrast CT scan and a specialised PET scan, did not clearly identify the cause. The breakthrough came with specialised blood tests measuring insulin and C-peptide levels, followed by a targeted endoscopic ultrasound (EUS), which ultimately helped locate the tumour.

The tumour’s small size and challenging location added a further layer of complexity. Measuring just 1.3 cm, it was located at the neck of the pancreas and surrounded by vital structures. The surgical team therefore opted for a robotic-assisted approach, using robotic intraoperative ultrasound (RIOUS) to accurately localise and safely remove the tumour.

The surgery was successful, with the patient’s blood sugar levels started normalising immediately after the procedure. She made a rapid recovery and was able to return to normal activity the very next day.

The diagnostic team was led by Dr. P. Basumani, Senior Consultant and Director, Kauvery Institute of Digestive Sciences, Kauvery Hospital, Vadapalani, while the robotic procedure was performed by Dr. Swaminathan Sambandam, Senior Consultant and Lead, Multi-Organ Transplant (Liver, Kidney, Pancreas and Small Intestine), Kauvery Hospital, Vadapalani.

In his comments Dr.  Basumani said, “Insulinomas are extremely difficult to locate, especially when they are very small. In this case, even advanced imaging did not give us clear answers. Specialised blood tests combined with focused Endoscopic Ultrasound Evaluation helped us precisely identify the tumour.”

Dr. Swaminathan Sambandam said, “This was a technically demanding surgery. Tumours of this size and location are extremely challenging to operate on through conventional methods. Robotic surgery, supported by intraoperative ultrasound, gave us unmatched precision and control. Very few hospitals in the country have access to this level of technology.”

In his comments, Dr Aravindan Selvaraj, Co-founder and Executive Director, Kauvery Group of Hospitals, said, “This case reflects the strength of clinical teamwork, perseverance in diagnosis, and the role of advanced technology in handling rare pancreatic and endocrine tumours. It reinforces Kauvery Hospital’s commitment to clinical excellence, advanced diagnostics and state-of-the-art robotic surgery.”