Last August Milford Regional added a state-of-the-art device to the Surgery Center that will especially benefit women undergoing breast surgery. Diana Caragacianu, MD, medical director of The Breast Center at Milford Regional, led the efforts in trialing this new technology at MRMC, demonstrating its safety and utility and resulting in the purchase of the Stryker SPY Portable Handheld Imager (SPY-PHI). This equipment uses fluorescence imaging technology that allows surgeons to visualize blood flow in vessels and related perfusion to an organ or a tissue. This type of intraoperative information acquired from the technology allows us to choose precise steps in surgery which optimizes the patient’s safest outcome.
Dr. Caragacianu has a passion for applying innovation in medicine and surgery. Her specialized international training in oncoplastic surgery and experience in intraoperative radiation therapy, as well various advances in precision medicine puts her on the leading edge of advanced technologies that benefit her patients. Before coming to Milford Regional last year, she was the site director of the breast program at MedStar Lafayette Center in Washington D.C. and a surgeon at Georgetown University Hospital.
“I used the SPY-PHI at Medstar Georgetown University Hospital and had the opportunity to observe how this technology really makes a difference in choosing the safest operation for the patient,” noted Dr. Caragacianu. “Technology advances so quickly now, and the goal of technology is to improve patient care quality, safety and outcomes. In medicine and surgery, it is so important to remain vigilant and aware of advances that benefit patients and work with the industry as well as hospital administration to bring beneficial technology to the patient bedside.”
Dr. Caragacianu explained that the SPY-PHI probe is small, handheld and that it connects to a tower with a screen. The surgeon injects a solution into the patient which travels to the organ of interest. This may be the mastectomy flaps, ensuring adequate perfusion, it may be a parathyroid after a thyroidectomy, a small bowel resection, or the localization of a lymph node. After injection of the fluorescent dye, the probe is placed over the organ of interest. The illumination of the organ on the screen confirms that the fluorescent dye traveled via vessels to the tissue, indicating the tissue has enough blood supply.
“This tells us if the tissue has a good blood supply. If there is poor blood supply, the image from the organ shows as black,” Dr. Caragacianu said. “If we don’t have a good blood supply, we can alter our steps to minimize complications. For example, during reconstruction we would not put a permanent implant but rather we would put a tissue expander which doesn’t put as much pressure on a compromised flap, and we will give the tissue a chance to heal. If we put an implant under a mastectomy flap and we don’t know it has compromised blood flow, we can actually make that flap worse and put patients at higher risk of complications. Without enough blood supply, the tissue could die off, so it’s very helpful to know the state of the blood supply to the tissue/organ of interest.”
Dr. Caragacianu uses the SPY-PHI at the end of a mastectomy before reconstruction and also during select oncoplasty procedures. In addition, she incorporates it into lymph node identification, thyroid and parathyroid surgeries, and general surgeons could find it helpful for bowel resections. “It’s a technology that makes surgery safer. This is not a cheap undertaking, and I am extremely proud and thankful to the hospitals’ administration that they prioritized patient safety first and purchased this equipment. I would not do surgery on anyone unless I know I can offer them the safest surgery available,” she concluded.