In thousands of operating rooms across the country, surgeons have to make the decision every day. Which tissue is viable? Where is the blood flow in tiny, microscopic vessels too compromised to allow healing? In the past, there has been little beyond experience to guide that judgment. Get it right, and healing can begin. Get it wrong, and painful complications can add thousands to medicals bills - and possibly even cost the patient his life.
Early this summer, Medical West Hospital became the first health care facility in Alabama to use the Spy EliteTM Intraoperative Perfusion Assessment System to give surgeons a real-time view of blood flow in small vessels. This technology by Life Cell enhances visualization of tissue perfusion, allowing potential problems to be detected and corrected while patients are still under anesthesia.
“Experience goes a long way in making decisions in the OR, but every patient is different. You can’t always judge by appearances,” general surgeon John Issis, MD said. “I recently performed a double amputation. The skin flaps looked healthy, and I fully expected the patient to do well. But she was a diabetic, and in diabetics, healing is always an issue we have to consider. So I used the system to double check perfusion. The blood flow in small vessels was compromised and the flaps would not have survived. That would have meant another trip to surgery and needless pain for the patient. But because I could see what needed to be done, I was able to take care of it then and there. She healed very well.”
Issis became interested in the Spy Elite System when he attended a seminar on hernia repairs using a biological mesh that is also made by Life Cell.
“The technology was originally used by military surgeons dealing with abdominal combat wounds. It has since been rolled out for civilian use, and the third generation of the equipment has added several new improvements,” Issis said. “We switch off the lights and scan the area with a laser that has an imaging head mounted on an articulating arm. A large display monitor provides real-time perfusion mapping by giving us a fluorescent image of microscopic blood vessels four to five inches into the abdomen. Areas where blood flow is better or worse show up as different colors, so we can immediately see what needs to be fine tuned before we close.
“The Spy Elite system is especially helpful in colon and small bowel resections. We can see if the tissue is healthy and likely to heal, or at risk for leakage, which could mean perforation, infection, pain and possibly even losing the patient. If we can prevent one bowel leak, it’s all worth it. It saves lives and the huge cost of dealing with complications.”
Medical West surgeons are also using the Spy Elite System in colorectal surgery, scar revision and hernia repair. Plastic surgeons are finding it helpful in verifying vascularization of skin flaps in breast reconstruction and similar procedures.
“We’re seeing better outcomes and fewer complications in the healing and recovery process. It’s great being able to base our clinical judgments on evidence rather than having to depend on educated guesswork,” Issis said. “You can’t use the system with patients who have a contrast intolerance or who might react to sulfur, but when you can, the improvements in outcomes we have seen have been amazing.”
Medical West surgeons are also finding the system helpful in communicating with patients.
“We can print out images of the blood flow and show them to patients so they have a better understanding of their condition or why more extensive surgery was necessary,” Issis said. “They seem to appreciate that the technology has helped them get better results and may very well have saved them another trip to surgery.”
After seeing how the capabilities of the technology are contributing to better outcomes in his own cases, Issis plans to share what he has learned with other surgeons by speaking on the topic at several locations in the coming year. He is perhaps even more excited by the potential he sees for the development of new applications in the future.
“Imagine if we could inject an agent to tag receptors so cancer cells light up and become visible. Surgeons would be able to check for any remaining tumor cells and remove them before they close. It could be a real game changer.”
