Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
Surg Endosc. 2010 Sep;24(9):2170-7. doi: 10.1007/s00464-010-0917-1. Epub 2010 Mar 13.
Despite rigorous health screening in astronaut crews, there are a number of conditions that may occur during long duration, exploration class spaceflight. The risk of abdominal conditions requiring surgical intervention is not clear, yet submarine and polar base experiences suggest contingency planning is warranted. While radio communication time delay is only 2 s to the international space station (ISS), a potential Mars mission would necessitate time delays of about 15 min. We sought to demonstrate the feasibility of remote expert guidance of diagnostic ultrasound followed by laparoscopic appendectomy in a simulated Mars environment.
Research was deemed exempt by the institutional review board. A simulated Mars research environment was utilized on Devon Island in the Canadian Arctic. Electronic communications including audio and video were established between the Arctic base and Henry Ford Hospital serving as Mission Control and incorporated the 15-min communications lag into all communication. Ultrasound and laparoscopic capabilities were integrated into communications for remote guidance. Remote guidance methods and technology utilized has been previously published in communication with the ISS. A simulated scenario involving a young female astronaut developing right lower quadrant pain was developed and utilized for this demonstration. An anatomical appendectomy model was utilized for the ultrasound and laparoscopic portions. Reference aids describing background technical aspects were developed. A set of confirmation milestones was used to generate a hard stop and mandated remote review.
The simulated appendectomy was successfully pursued on the first attempt with no delays or untoward events. Reference aids were appropriate for non-surgical personnel and hard stops for milestones with remote approval and go ahead were shown to be feasible. The appendicitis was appropriately diagnosed utilizing remote guidance of ultrasonography and the appendix removed laparoscopically using stapled technique with remote guidance as well.
We report a successful remote guidance demonstration from a simulated mars environment with clinical control from a terrestrial base utilizing appropriate delay and consistent bandwidth and technology.
尽管在宇航员机组人员中进行了严格的健康筛查，但在长时间、探索性的太空飞行中仍可能出现一些情况。需要手术干预的腹部状况的风险尚不清楚，但潜艇和极地基地的经验表明，有必要进行应急计划。虽然与国际空间站（ISS）的无线电通信时间延迟仅为 2 秒，但潜在的火星任务将需要大约 15 分钟的时间延迟。我们旨在证明在模拟火星环境中远程指导诊断性超声检查后进行腹腔镜阑尾切除术的可行性。
机构审查委员会认为该研究无需审查。在加拿大北极的德文岛利用模拟火星研究环境。电子通信（包括音频和视频）在北极基地和亨利福特医院之间建立，后者作为任务控制中心，并将 15 分钟的通信延迟纳入所有通信中。超声和腹腔镜功能被集成到远程指导的通信中。远程指导方法和技术已在与国际空间站的通信中进行了先前的发表。针对一名年轻女宇航员出现右下象限疼痛的模拟情况开发并利用了该模拟场景。使用解剖阑尾模型进行超声和腹腔镜部分。开发了描述背景技术方面的参考辅助工具。使用了一组确认里程碑来生成硬停止并强制进行远程审查。
首次尝试就成功进行了模拟阑尾切除术，没有出现任何延迟或意外事件。参考辅助工具适合非手术人员使用，里程碑的硬停止和远程批准以及前进的许可被证明是可行的。通过远程指导超声检查适当地诊断了阑尾炎，并使用远程指导的吻合钉技术进行了腹腔镜阑尾切除术。
我们报告了一项从模拟火星环境进行的成功远程指导演示，该演示由陆地基地的临床控制进行，利用了适当的延迟、一致的带宽和技术。
