Extreme house calls

What happens when an astronaut moving heavy equipment to explore the moon's surface injures a leg? Even if no physician or surgeon is aboard the spacecraft, fellow crewmembers might soon be able to perform emergency surgery using remotely controlled surgical robots and a high-speed audio/video link to surgeons back on Earth.

In spring 2006, U.S. and Canadian officials will test the advanced technologies needed to deliver remote medical assistance as part of the next stage of the NASA Extreme Environment Mission Operations (NEEMO) project.

In the upcoming NEEMO 9 drill, a surgeon in Toronto will communicate with astronauts aboard a seacraft submerged 62 feet below waters off the Florida coast and guide them through a simulated orthopedic surgery.

Conditions aboard the Aquarius seacraft are designed to mimic the extreme environment of space, but the exercise has even broader implications for telemedicine, which could be useful on battlefields and in remote rural areas where trained medical professionals are scarce.

"The goal is to reduce the burden on the person locally and allow the work to be done at a distance, to enable someone who is not trained at a specific task but is responding to an emergency in an extreme environment," said Dr. Mehran Anvari, director of the Centre for Minimal Access Surgery (CMAS) in Hamilton, Ontario. He was chief scientific officer for NEEMO 7.

NASA conducted that test last year with CMAS and the Canadian Space Agency. Next spring, NASA will launch the NEEMO 9 mission to probe deeper into certain aspects of telerobotics.

"NEEMO 7 was designed to address a central question we needed answered," said Gerry Moses, director of the Clinical Applications Division at the Army Medical Research and Materiel Command's Telemedicine and Advanced Technology Research Center.

That question was: Can a relatively unskilled worker successfully care for a patient with the assistance of a skilled surgeon in another location?

The Army center is funding NEEMO missions because of the crucial role it expects telemedicine to play in battlefield operations.

During NEEMO 7, astronauts under Anvari's remote guidance successfully manipulated tissue extracted from a pig, demonstrating that telementoring is possible even under the most extreme circumstances.

However, scientists also uncovered weaknesses in the application. "A key problem in the last mission was the robotics, which were too bulky [because] they were not sized to fit the Aquarius," Anvari said. NEEMO officials are working with the manufacturer, SRI International, to explore the possibility of constructing a smaller, more portable robot for use during NEEMO 9.

During NEEMO 9, space officials will also address latency and jitter issues associated with the high-speed networks that power the mission's telerobotics and communications links.

Latency can't be eliminated entirely, so exploring its impact on the mission has become a central theme of NEEMO 9.

Essentially, NEEMO 9 is designed to bolster all aspects of performing remote surgery.

"Just being able to speak with someone does not mean you can help them perform surgery," Anvari said. "For us it is critical that we understand and tweak all aspects of the system."