title: Endoscopic surgery and telemedicine in microgravity: developing contingency procedures for exploratory class spaceflight.
abstract: OBJECTIVE
  The risk of a urinary calculus during an extended duration mission into the reduced gravity environment of space is significant. For medical operations to develop a comprehensive strategy for the spaceflight stone risk, both preventive countermeasures and contingency management (CM) plans must be included.
  
  
  METHODS
  A feasibility study was conducted to demonstrate the potential CM technique of endoscopic ureteral stenting with ultrasound guidance for the possible in-flight urinary calculus contingency. The procedure employed the International Space Station/Human Research Facility ultrasound unit for guide wire and stent localization, a flexible cystoscope for visual guidance, and banded, biocompatible soft ureteral stents to successfully stent porcine ureters bilaterally in zero gravity (0g).
  
  
  RESULTS
  The study demonstrated that downlinked endoscopic surgical and ultrasound images obtained in 0g are comparable in quality to 1g images, and therefore are useful for diagnostic clinical utility via telemedicine transmission.
  
  
  CONCLUSIONS
  In order to be successful, surgical procedures in 0g require excellent positional stability of the operating surgeon, assistant, and patient, relative to one another. The technological development of medical procedures for long-duration spaceflight contingencies may lead to improved terrestrial patient care methodology and subsequently reduced morbidity.
authors.affiliation: National Aeronautics and Space Administration/Johnson Spacecraft Center and University of Texas Medical Branch Aerospace Medicine Program, Houston, Texas 77058, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Jones
authors.forename: S
authors.initials: S
authors.lastname: Johnston
authors.forename: M
authors.initials: M
authors.lastname: Campbell
authors.forename: B
authors.initials: B
authors.lastname: Miles
authors.forename: R
authors.initials: R
authors.lastname: Billica
mesh_terms: D004724:Endoscopy; D005240:Feasibility Studies; D006112:Gravitation; D006801:Humans; D012307:Risk Factors; D013026:Space Flight; D017216:Telemedicine; D014463:Ultrasonography; D014545:Urinary Calculi / Q000000981:diagnostic imaging / Q000628:therapy*