With the privatisation of space travel more people, even civilians, will have the chance to experience deep space exploration. With this new opportunity comes a lot of questions, one of which is: what happens if someone needs surgery in space?
Performing surgery on humans in a microgravity environment has never been done before. Astronauts have been living for short stints on the International Space Station (ISS) since its launch in 1998. During this time on the ISS, and more generally in manned spaceflight, the procedure for dealing with a surgical emergency has been to stabilise the patient and get them transported back to Earth. This is possible because the relatively low orbit of the ISS allows for real time communications and emergency evacuations. This, however, will not be possible when humans begin exploring Mars. Because of the effects of spaceflight, the delay in communications can be up to 20 minutes each way and the chances of shuttling home are zero. It’s expected that 1 surgical emergency will occur every 2.4 years on a mission to Mars.
In the case of medical emergencies onboard a spacecraft, the main challenge facing astronauts are the effects of microgravity, for example:
• Both the surgeon and patient must be strapped down to prevent either one from drifting away.
• Blood and other fluids can stick to the instruments because of the change in surface tension.
• Traditional surgical techniques for common aliments like appendicitis require large incisions and potential bleeding, leading to blood floating in the environment, a potential issue for everyone on board.
• Surgical equipment can be bulky and largely incompatible with the confined, strictly organised environment of a space capsule.
To tackle these issues, scientists in space agencies around the world have been developing some of the biggest advances in surgical care and technology.
For medical devices to be used in space, they need to be both smart and light. By adding connectivity to devices like ultrasound imaging equipment, astronauts can carry out scans on a patient onboard and doctors on the ground can review the images live and report back with a diagnosis.
By improving the portability of devices like imaging equipment, they can be accommodated on board a space capsule far more easily than their traditional counterpart. There are even plans for robot-assisted surgery that could be controlled by specialist surgeons remotely, allowing patients to undergo emergency operations without emergency repatriation.
For emergencies in space that occur on long journeys, passengers will not be able to rely on help from the ground. This is being addressed through the ‘deskilling’ of procedures.
This is the process through which common procedures are adapted for unskilled space travellers allowing them to perform complex surgical steps with very little training. This is possible by reworking the equipment involved to be less invasive, more specialist to the procedure and more intuitive. It would allow anyone with a general level of training to complete basic procedures with little risk.
3D printers are being tested in simulated space environments to understand whether surgical instruments can be 3D printed on demand to deal with emergencies that occur during human space travel. Using plastic material, a range of surgical instrumentation can be produced in a few hours and disposed of upon completion of the procedure. This ultimately saves space and weight onboard which is crucial for long-term missions while improving the surgical interventions available to the crew. These advancements mean that all astronauts would need to access the right equipment in case of a surgical emergency is an internet connection and a 3D printer.
All these developments don’t just keep a healthy crew in space. Back on Earth, people in low-income countries are struggling to access good healthcare. There are several reasons for this and among those are poor infrastructures, a lack of highly skilled medical professionals and people living in remote or isolated places without access to surgical care. These issues are similar to the ones that occur in space.
Smarter, connected devices enable doctors from anywhere in the world to have an input in surgical procedures happening in areas deprived of trained professionals. Such devices could be connected diagnostic ultrasound imaging devices or surgical robots being operated by a surgeon in one country completing a complex operation on patients in another country.
Deskilling common surgical procedures means equipment and training can be made available to more users. If more people can be trained, more patients can have access to treatment at a lower cost and with greater ease. Patients can undergo treatment with a general practitioner or nurse in their local clinic as opposed to seeking specialist treatment miles from their homes.
Advancements in surgical technology are already having a big impact on people’s lives on Earth but there is still a lot of work to be done before astronauts can safely operate in space. With private space exploration companies planning to send the first uncrewed spaceship to Mars in 2024, space healthcare better be ‘all systems go’.
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