Presentation Authors: Kevin Hebert*, Jason Joseph, Boyd Viers, Rochester, MN
Introduction: Genitourinary reconstructive surgery often involves patient populations at risk for reduced tissue perfusion. In the setting of complex fistula disease, many patients have significant history of external beam radiation therapy, further compromising blood flow. Previous method of intraoperative assessment of tissue viability relied on direct surgeon visualization. SPY-PHI (Stryker Kalamazoo, Michigan), is a portable hand held device using near-infrared laser technology and indocyanine green to assess for tissue perfusion. We sought to compare subjective intraoperative surgeon assessment of tissue perfusion to objective perfusion using SPY-PHI technology.
Methods: We utilized SPY-PHI in a cohort of 8 patients undergoing open, complex genitourinary reconstructive surgery for acute trauma or complex fistula disease between September 2017 and November 2018 at Mayo Clinic.
Results: Seven patients in our cohort underwent multi-modality reconstructive surgery due to fistulous disease as a result of prior radiation therapy. In 7 of 8 cases, discordant subjective intraoperative surgeon assessment of tissue viability was seen when compared to assessment of tissue perfusion using SPY-PHI. The most common difference noted was in evaluation of the length of ureteral viability.
Conclusions: In our recent experience, near-infrared laser assessment using SPY-PHI technology is a useful adjunct for real-time intraoperative evaluation of tissue viability in complex genitourinary reconstructive surgery. More short and long-term data are necessary to evaluate the potential role of SPY-PHI technology in genitourinary reconstructive surgery.