Space surgical tools

The makers of Star Trek were way ahead of their time. The cabin crew of the famous science fiction TV show consisted of a captain, a scientific officer, an engineer and… a medical officer.

Now, as increasingly our ambitions in space include manned trips to asteroids and Mars, we may have to take a leaf out of Star Trek's book.

And at Carnegie Mellon University in Pittsburgh, Pennsylvania, two biomedical engineers and a medical surgeon are developing just the surgical tools that could be used on a mission.

They are developing a watertight surgery system - an Aqueous Immersion Surgical System - that can isolate wounds and control bleeding by creating a pressurized aqueous environment within the surgical field.

Interplanetary travel

Jennifer Hayden, a PhD student in Biomedical Engineering and member of the research team at Carnegie Mellon, says medical assistance will become an important factor on future space flights.

"NASA has done a lot of research into [this] and compiled the risks they see for health care in space," says Hayden. "They predict that as we go further into deep space - so, interplanetary travel - and with a crew of six members on a multi-year mission, the likelihood of needing surgery is actually quite high."

But Hayden says there are several challenges that need to be addressed before we will be able to conduct surgery in space.

"We will be addressing [some of these challenges] with our technology - one being, preventing cabin contamination with blood and other bodily fluids, and two, reducing the amounts of blood lost during surgery."

Using an experimental chamber

To conduct their experiments, the research team at Carnegie Mellon uses a watertight cylindrical chamber that is large enough to fit an organ, such as a pig heart.

"Our first instinct was to create an artificial tissue that you would just make in the lab and recycle - it's repeatable" says James Antaki, a professor of biomedical engineering and team member. "Something like a dialyzer which has lots of little tubes that represent capillaries. But it turned out that there was no substitute for real tissue. The heart was just convenient because it has all these coronary vessels on the outside."

The heart is placed inside the experimental chamber and the chamber is filled with fluid. The research team then inflicts a trauma on the heart to cause bleeding. This increases pressure inside the chamber until it is higher than the vessel that is bleeding. This eventually stops the bleeding and the wound can be closed, using standard surgical techniques.

The next step will be to perform live surgery on an animal, most likely a rat.

"And that's one step closer to convincing people that it can really work on people," says Antaki.

Injuries in Space

You would think that accidents in space are rare - especially as astronauts undergo a strenuous physical training. But the strongest are at most risk.

"The healthiest and most physically fit people are the ones that get injured [in space]", says medical surgeon, James Burgess. "They are the ones that take chances, they are the ones that are involved in traumas, they are the ones that have the rib fractures, the head fractures, the spleen injuries and all that."

Hayden adds that astronauts face the greatest risks when moving large, heavy equipment.

"Although there is no gravity, so it would appear that the equipment itself is weightless, it still has high mass. So it can generate significant forces and once that piece of equipment has started moving, it's going to be difficult to stop," says Hayden.

And when accidents happen, the most important factor is blood. In zero gravity, blood will float through a cabin and potentially contaminate other crewmembers. The loss of blood also needs to be limited as much as possible, since blood transfusions are practically impossible in space.

"Human physiology is not meant to be in space for long periods of time," says Burgess. "And if astronauts are in extended travel, they are going to be in less and less optimal shape. So, probably what you are going to see is trauma happening more and more frequently the longer people are up there. Avoiding blood loss during surgery is going to be a very high priority because blood is like gold in a situation like that. What we are doing is addressing the loss of something that is very, very important."

Medical Skills

But if surgery in space is to become a reality, it will require specially trained medical professionals to accompany the crew of astronauts.

"The skills that are going to be necessary are not quite clear yet," says Burgess. "Is it a fully trained general surgeon for example who should be there? Or should it be someone who is specialized in a certain area or that can be cross-trained in a variety of types of surgery? What are the most likely surgical problems that you are going to end up seeing? Since it has not been done yet, there is no data."

Space medicine exists as a discipline at medical school. But the format is solely conceptual and does not prepare students for actual medical assistance on space flights.

"It would be very unlikely that the volumes of people who would like to spend two or three years traveling between interstellar bodies would fill much of a classroom at a space school," suggests Burgess. "But you are going to find people that are very interested in pursuing that."

The earliest that space crews might need a medical officer, such as the one on Star Trek, is likely to be 2025 - by which time US President Barack Obama says he wants astronauts to travel to an asteroid. He also wants manned trips to Mars by sometime in the 2030s.

That doesn't mean that the surgical tools being developed at Carnegie Mellon will go unused until then. They could be used in regular hospitals or on military battlefields.

But the goal is to have medical officers on space missions, equipped with the appropriate tools to perform surgery - sooner rather than later. And when that happens, the science fiction of Star Trek will be science fiction no more.