Surgical Techniques in Parabolic Flight

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Surgical Techniques in Parabolic Flight

• Mark R. Campbell, M.D.
• December 3, 2005
• Houston Texas

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Surgical Hardware Constraints

• Power
• Volume
• Mass
• Complexity
• Reliability
• Ability to Maintain and Repair

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Medical Evacuation Concerns

• Re-entry 1.8g (Shuttle) to 6.0g (CEV)
• Class II hemorrhage
• Deconditioned astronaut
• 10 plasma loss
• Baroreceptor loss
• Anemia
• Cardiac deconditioning (10 loss in SV)

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Robotic Surgery

• Currently still not conventional
• Hardware constraints
• Increased training time
• Equipment unreliable and not repairable
• Limited use for specific problems
• Communication delay too large

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Thorascopy

• Poor visualization due to lack of gravitational
  retraction of mediastinum
• Lack of selective bronchial intubation
• Poor drainage of fluid from chest cavity by
  chest tubes due to fluid dispersal

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Ultrasound in Parabolic Flight

• Pneumothorax air is centrally loculated
• Chest fluid does not loculate, but disperses
  within the chest cavity
• Abdominal fluid (blood) does not loculate
  posteriorly, but stays where it is created
• Ultrasound useful for pneumothorax detection and
  for percutaneous techniques
• Easily trainable and telementoring feasible

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Parabolic Flight Conclusions

• Restraint can be accomplished by simple methods
  for patient and CMO
• Instrument restraint is important and needs to be
  planned for in the system
• Bleeding can be controlled
• ATLS procedures can be performed
• Complex surgical procedures can be performed. Not
  more difficult, but require increased time to
  perform.
• Fluids behave differently than in 1g.

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NASA Surgical Training Working Group - 2003

• What surgical diseases do we need to be able to
  treat
• What surgical procedures do we need to be able to
  perform
• What surgical skills do we need to teach the
  Expedition Medical Officer
• How do we train the Expedition Medical Officer

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Conclusions NASA Surgical Training Working Group

• - Need to have enough surgical capability to
  perform major open procedures (exploratory lap
  and appendectomy)
• - Some surgical diseases can not be treated
  (Vascular surgery is not trainable)
• - Laparoscopy may not be available
• - Many procedures can be performed with imaging
  and percutaneous techniques

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NASA Surgical Training Working Group

• Need surgically trained CMO (level of second year
  resident in selected areas)
• Expedition Medical Officer will be trained in
  multiple disciplines
• Need an M.D. who has already finished a board
  certified residency
• Can train with a two year program (six months of
  surgical training)

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