title: Simulated hand-assisted laparoscopic surgery (HALS) in microgravity.
abstract: BACKGROUND
  Previous simulation and porcine experiments aboard the reduced gravity program KC-135 turbojet have demonstrated that microgravity surgery is feasible. Ideally, surgical care in spaceflight will incorporate recent advances in care while remaining easy enough for a crew medical officer (CMO) lacking surgical proficiency or extensive surgical experience to perform. As a minimally invasive surgical technique, hand-assisted laparoscopic surgery (HALS) benefits the patient via smaller incisions, less pain, and faster recovery than traditional open surgery. HALS also helps less experienced laparoscopic surgeons perform laparoscopic surgery.
  
  
  METHODS
  An inexpensive inanimate surgical simulator was constructed to evaluate the usefulness of HALS in microgravity. This simulator was utilized during brief periods of microgravity provided by parabolic flight on the KC-135. The simulator was successfully used by both a physician-astronaut and an experienced laparoscopic surgeon. Task completion included simulated surgery with exploration of the intestines and ligation of the appendix.
  
  
  RESULTS
  Simulated HALS was successfully performed in microgravity. HALS effectively contained operative equipment and small amounts of introduced fluids within the simulated abdominal cavity. Astronaut and surgeon experience suggest that HALS could facilitate minimally invasive surgery (MIS) in microgravity.
  
  
  CONCLUSIONS
  HALS holds promise as a surgical approach in microgravity, particularly as space travel extends beyond low earth orbit. HALS provides the benefits of MIS, facilitates MIS surgery by less surgically proficient or experienced CMOs, and contains equipment and fluid within the operative field. Simulation provides an easy, cost-effective platform to evaluate medical technology for space flight as well as a method to train CMOs on-orbit.
authors.affiliation: Department of Surgery, Center for Surgical Innovation, University of Cincinnati, Cincinnati, Ohio, USA.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Broderick
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Privitera
authors.forename: Scott E
authors.initials: SE
authors.lastname: Parazynski
authors.forename: Marsh
authors.initials: M
authors.lastname: Cuttino
mesh_terms: D001065:Appendix / Q000601:surgery; D006801:Humans; D007422:Intestines / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D014893:Weightlessness; D018474:Weightlessness Simulation