Space Surgery Possible with Zero-Gravity Tool

By Will Ferguson (29 September 2012) DRAINING an infected abscess on Earth is a straightforward procedure. On a spaceship travelling to the moon or Mars, it could kill everyone on board. Blood and bodily fluids cannot be contained in zero gravity, which means there is currently no way to perform surgery in space without contaminating the cabin. This makes an extended stay problematic, says James Antaki at Carnegie Mellon University in Pittsburgh, Pennsylvania. "Based on statistical probability, there is a high likelihood of trauma or a medical emergency on a deep space mission," he says. Antaki is part of a team of US researchers developing an astro-surgical tool that could help. The Aqueous Immersion Surgical System, or AISS, is a transparent box that creates a watertight seal when it is placed over a wound and pumped full of sterile saline solution, says George Pantalos at the University of Louisville in Kentucky. The saline solution is held under pressure inside the AISS to prevent blood from seeping out of the wound. Airtight holes allow surgeons to access the submerged wound using handheld and orthoscopic instruments. By varying the pressure within the AISS, the device could also be used to siphon up and recycle blood. "You won't have a blood bank in space, so if there is bleeding you want to save as much blood as you can," says James Burgess, also at Carnegie Mellon, who came up with the concept. Researchers will put the system to the test aboard NASA's zero-gravity C-9 aircraft next week in the first of several experiments planned. They will perform surgery on an artificial coronary system filled with synthetic blood to test its ability to keep blood inside the body and out of the surgeon's field of view. Other experiments are likely to include a sub-orbital flight test, says Pantalos. Tams Haidegger, a bioengineer at Budapest University of Technology and Economics in Hungary, says the AISS or a similar device will be an essential tool on future space flights to an asteroid, Mars or even aboard the International Space Station. ISS astronauts could soon be increasing their stay from six months to a year. In the event of a medical emergency on board the space station, the only current option is to evacuate the astronaut back to Earth. This is not only dangerous for the patient but it is also extremely expensive, says Haidegger. Fortunately, however, no such emergency has yet occurred. According to Haidegger, it will not always be necessary to have a doctor on board the spacecraft - a surgeon on Earth could assist with invasive surgical procedures via a teleoperated robot, making a hasty return to Earth unnecessary (Acta Astronautica, doi.org/jdx). The new device could play a part in such space surgery. In the short term, Pantalos says the AISS may be useful in operating theatres back on Earth for example, for brain and spine surgery, where bleeding presents serious complications. http://www.newscientist.com/article/mg21528843.600-space-surgery-possible-with-zerogravitytool.html

New Technology Enables Quick and Scarless Surgery for Stomach Tumors
July 5, 2011 Patients with gastric tumors in their stomach will no longer have to suffer an eight-hour long surgery, but instead can look forward to a short day surgery which last a few minutes to an hour without the need for hospitalization. This new procedure -- the world's first flexible endoscopy robotic surgery in the stomach -was successfully performed on patients suffering from gastric tumor in India. The procedure was performed on a total of three patients, one patient per day from July 1 to 3. A flexible endoscope (small tube inserted in intestinal tracts) which had small robotic arms, was inserted through the patient's mouth to the stomach, while the surgeon monitored it on a computer screen. Using joystick and buttons to control the robotic arms, the surgeon then removed the cancerous tumor and the patient went home after the operation. This groundbreaking technology was developed by Associate Professor Louis Phee, Head of the Division of Mechatronics and Design, School of Mechanical and Aerospace at Nanyang Technological University and Professor Ho Khek Yu Lawrence, Senior Consultant at the Department of Gastroenterology and Hepatology, National University Hospital, after six years of research. This system, named MASTER (Master and Slave Transluminal Endoscopic Robot) is entirely designed and built from scratch in NTU. Current robotic keyhole surgeries still require a small cut at the stomach area to enable a rigid robotic endoscope to enter and do the surgery. This new flexible robotic endoscope does not require any external incision, and enters through the mouth instead. By controlling an external console, the surgeon is able to make the robot perform intricate surgical procedures. For the surgeries done in India, the robot is used to perform Endoscopic Submucosal Dissection (ESD): the delicate removal of a tumor embedded in the stomach wall without puncturing the latter. Without this robotic system, a patient is likely to undergo open surgery to remove the tumor. As ESD is considered a very difficult procedure, the robot is easily modified to perform many other procedures within the digestive tract. This novel procedure also opens up new possibilities for surgery: the robot is able to cut a small hole in the stomach wall to get access to other organs like the liver, kidney, and pancreas to perform intricate surgery. After the surgery is done, it slides back into the stomach, mends the hole in the stomach wall and exits out of the mouth again. It may come a time when a patient goes for surgery and all he or she needs do is open their mouth. Apart from speeding up the operation process and leaving no scars, this robotic procedure is also significantly cheaper than normal surgery thanks to its precision, dexterity and maneuverability. The robotic arms, which is up to six millimeters in diameter, has the capacity to "feel" how hard or soft the delicate tissues of the stomach and intestines are, so doctors at the console can vary the pressure accordingly. The combined diameter of both arms is up to 16 mm. In future, it may be possible for such a surgical system to be controlled remotely from another part of the world. To carry out the experiments on the device's effectiveness and efficiency, a multicenter experiment was decided as collaborators from Hong Kong and Germany have shown keen interests. Since the Asian Institute of Gastroenterology (AIG) was the first to get the relevant approvals for human trials and patients were easily available there, they were the first center to carry out the operation.

AIG is one of Asia's largest outpatient centers doing therapeutic endoscopy, and has the credit of doing the most ERCP (Endoscopic retrograde cholangiopancreatography) procedures in the word. In addition, Dr Nageshwar Reddy, chairman and chief gastroenterology at AIG, is one of the best gastroenterologists in the world and is known for his innovations. With the experimental operation carried out under his supervision, it would give the new surgical procedure a lot of credibility. Dr R. Pradeep, the AIG surgeon who did the operations in India, was in Singapore last year to train on the prototype system for a week. AIG is a partner in performing the first operation and does not share the Intellectual Property with regards to this invention, which is patented. The future plan will be to expand trials to other centers such as in Hong Kong and Germany. While relevant approvals have already been given to proceed with human trials in Singapore, patients with this particular ailment in Singapore are rare and are not easily found. The research project is funded by NTU and the National Medical Research Council (NMRC), supported by Singapore Gastric Cancer Consortium (SGCC) http://www.sciencedaily.com/releases/2011/07/110705123348.htm