A Different Kind of Surgery – Zero gravity, Robotics and a 3D printer

Illustration by Sam Wilson

Space has become a place that has provided Earth with incredible discoveries. In the process it has helped us answer how and why our planet is how it is, helped us advance technology due to our curiosity into space exploration and answers many theories scientists have and/or had about the universe.

Earlier this year, a study was carried out to assess the effect of space on the internal jugular vein. With those taking part not displaying any alarming symptoms, it would have been easy to miss a blood clot that had developed in one of the astronauts had it not been for the study.

Obviously, being very far from Earth at the International Space Station (ISS) it would be ludicrous to think of waiting for a doctor to make a ‘home visit’ to space to assess an astronaut. So instead, evaluation and treatment was attempted over a phone call. Normally, the use of blood thinners would be used over a course of months to prevent such a clot from getting any bigger but there is always increased risk that if an injury were to occur, taking blood thinners could cause internal bleeding that would be difficult to treat. Especially under zero gravity conditions and from our understanding that blood flow and tissue fluid shifts towards the head in space (EEK!).

The astronaut was eventually treated using an anticoagulant drug that was sent up after daily injections of blood thinners, which they had to take until they received the medication. Upon landing and after 24 hours they found the blood clot had disappeared. Having no symptoms or a family history of blood clots, the astronaut’s case was a clear indication that the human body undergoes changes in space that still surprise us and suggest there is still much to learn about aerospace medicine and space physiology.

That being said what would happen if an astronaut needed more than a life saving drug and instead needed immediate surgery? Would their guts and fluids just float around in Space? Is it even possible?

Many studies related to health and medicine have been carried out in space and continue to. January 1990: Three mission specialists on the Columbia STS-32 mission test out an Echocardiograph, a medical ultrasonic imaging system used with a lower body negative pressure unit. The test subject is G David Low, while Marsha S Ivins and Bonnie J Dunbar carry out the test. NASA/Space Frontiers/Getty Images

Researchers in space medicine say quite a few procedures have been carried out in zero gravity simulations with many challenges of performing surgery in a zero gravity environment being minimised using laparoscopic techniques (keyhole surgery).

According to Pete Hodkinson, specialty registrar in Aviation and Space medicine at the University of Cambridge, “it would be better to evacuate an individual requiring major surgery rather than attempt it in orbit” as there is a spacecraft attached to the ISS that could be used for emergency evacuation. Although without evacuation some surgeons speculate that surgery could be done but there is a lot to consider such as movement of organs during procedure, shelf life of medications for potential long missions such as a 3 year mission to Mars, how anaesthesia would work in space and if most procedures would be able to be carried out through telementoring techniques.

While use of robotic surgery and 3D printing technology have been considered in future methods for carrying out microsurgery and providing astronauts with the supplies they need to do such operations.

More on this can be seen here in this video.

Referring back to the use of 3D printing technology for uses in surgery and space medicine, one of the things scientists have been working on is the use of the 3D BioFabrication Facility (BFF) considered to be the first 3D printer capable of manufacturing human tissue in space conditions. Its success could lead to benefits down on Earth as well, with the ability to 3D print human organs that could be constructed from the patient’s own cells to reduce the possibility of the body rejecting the new organ. This could lead to organ donor waiting lists becoming a thing of the past and surgery that is far less risky.

Overall, there remains a lot for us to learn in the area of aerospace medicine and surgery but I’m positive that just like many discoveries we’ve made from learning about space, any further knowledge can help to benefit those who still have their feet planted firmly on solid ground.

Further reading and videos on this topic:

http://www.techshot.com/bioprinter/

Brad Pitt speaking to NASA Astronaut Nick Hague Aboard the International Space Station https://www.youtube.com/watch?v=_oVYSwmIrZk&t=208s

https://publishing.rcseng.ac.uk/doi/pdf/10.1308/rcsbull.2015.97.5.208

https://theconversation.com/from-floating-guts-to-sticky-blood-heres-how-to-do-surgery-in-space-141837