The Martian chronicles: remotely guided diagnosis and treatment in the Arctic Circle.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
Christian
C
Otto
Jean-Marc
JM
Comtois
Ashot
A
Sargsyan
Alexandria
A
Dulchavsky
Ilan
I
Rubinfeld
Scott
S
Dulchavsky
D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000000981:diagnostic imaging* / Q000601:surgery*; D001110:Arctic Regions; D018480:Astronauts; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D018535:Mars; D016544:Patient Simulation; D019114:Remote Consultation / Q000379:methods*; D013026:Space Flight; D014463:Ultrasonography / Q000379:methods*; D020535:Video-Assisted Surgery / Q000379:methods