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microgravity surgery

Mark H Wilson
For 200 years, the 'closed box' analogy of intracranial pressure (ICP) has underpinned neurosurgery and neuro-critical care. Cushing conceptualised the Monro-Kellie doctrine stating that a change in blood, brain or CSF volume resulted in reciprocal changes in one or both of the other two. When not possible, attempts to increase a volume further increase ICP. On this doctrine's "truth or relative untruth" depends many of the critical procedures in the surgery of the central nervous system. However, each volume component may not deserve the equal weighting this static concept implies...
August 2016: Journal of Cerebral Blood Flow and Metabolism
Heyong Yin, Yu Wang, Zhen Sun, Xun Sun, Yichi Xu, Pan Li, Haoye Meng, Xiaoming Yu, Bo Xiao, Tian Fan, Yiguo Wang, Wenjing Xu, Aiyuan Wang, Quanyi Guo, Jiang Peng, Shibi Lu
UNLABELLED: We propose a method of preparing a novel cell carrier derived from natural cartilage extracellular matrix (ECM), designated cartilage ECM-derived particles (CEDPs). Through a series of processes involving pulverization, sieving, and decellularization, fresh cartilage was made into CEDPs with a median diameter of 263 ± 48 μm. Under microgravity culture conditions in a rotary cell culture system (RCCS), bone marrow stromal cells (BMSCs) can proliferate rapidly on the surface of CEDPs with high viability...
March 2016: Acta Biomaterialia
Benjamin C Gadomski, Kirk C McGilvray, Jeremiah T Easley, Ross H Palmer, Brandon G Santoni, Christian M Puttlitz
The reduction in mechanical loading associated with space travel results in dramatic decreases in the bone mineral density (BMD) and mechanical strength of skeletal tissue resulting in increased fracture risk during spaceflight missions. Previous rodent studies have highlighted distinct bone healing differences in animals in gravitational environments versus those during spaceflight. While these data have demonstrated that microgravity has deleterious effects on fracture healing, the direct translation of these results to human skeletal repair remains problematic due to substantial differences between rodent and human bone...
September 22, 2014: Journal of Biomechanics
David J Lerner, Allen J Parmet
Explorer Class missions face situations requiring innovative answers, including medical/surgical dilemmas. Interventional radiology (IR) could play a very important role as sonographically guided procedures make possible many minimally invasive surgical solutions. A review of IR was performed, including performing many IR procedures. Surgical equipment is limited in microgravity. General anesthesia, surgical skill, large mass/volume equipment, and postsurgical/postanesthesia care are among the reasons that open compartment/laparoscopic procedures are undesirable...
December 2013: Aviation, Space, and Environmental Medicine
Benjamin C Gadomski, Kirk C McGilvray, Jeremiah T Easley, Ross H Palmer, E J Ehrhart, Kevin K Haussler, Raymond C Browning, Brandon G Santoni, Christian M Puttlitz
Microgravity and its inherent reduction in body-weight associated mechanical loading encountered during spaceflight have been shown to produce deleterious effects on important human physiological processes. Rodent hindlimb unloading is the most widely-used ground-based microgravity model. Unfortunately, results from these studies are difficult to translate to the human condition due to major anatomic and physiologic differences between the two species such as bone microarchitecture and healing rates. The use of translatable ovine models to investigate orthopedic-related conditions has become increasingly popular due to similarities in size and skeletal architecture of the two species...
February 2014: Journal of Biomechanical Engineering
Matthieu Komorowski, Sharmila D Watkins, Gilles Lebuffe, Jonathan B Clark
In spaceflight beyond low Earth's orbit, medical conditions requiring surgery are of a high level of concern because of their potential impact on crew health and mission success. Whereas surgical techniques have been thoroughly studied in spaceflight analogues, the research focusing on anesthesia is limited. To provide safe anesthesia during an exploration mission will be a highly challenging task. The research objective is thus to describe specific anesthesia procedures enabling treatment of pre-identified surgical conditions...
March 2013: Aviation, Space, and Environmental Medicine
Richard T Jennings, Owen K Garriott, Valery V Bogomolov, Vladimir I Pochuev, Valery V Morgun, Richard A Garriott
BACKGROUND: A total of eight commercial spaceflight participants have launched to the International Space Station (ISS) on Soyuz vehicles. Based on an older mean age compared to career astronauts and an increased prevalence of medical conditions, spaceflight participants have provided the opportunity to learn about the effect of space travel on crewmembers with medical problems. The 12-d Soyuz TMA-13/12 ISS flight of spaceflight participant Richard Garriott included medical factors that required preflight intervention, risk mitigation strategies, and provided the opportunity for medical study on-orbit...
February 2010: Aviation, Space, and Environmental Medicine
David L Dawson
While discussions of the practicality of surgery in space often focus on technical issues, such as adapting instrumentation and procedures for use in microgravity, programmatic issues need to be addressed if meaningful capabilities for emergency surgery are to be considered for human exploration missions beyond low Earth orbit. Advanced technologies that have been evaluated, including simulation-enhanced training, telementoring, or robotic assistance, might help prepare or augment a crew medical officer, but a physician with advanced training and relevant experience will be needed if surgical capabilities beyond basic emergency aid are to be considered...
July 2008: Aviation, Space, and Environmental Medicine
Jingbo Zhao, Jill M Wecht, Yuanfei Zhang, Xialing Wen, Richard Zeman, William A Bauman, Christopher Cardozo
Orthostatic hypotension commonly occurs in persons with spinal cord injury (SCI), limiting rehabilitation and independence. Findings of increased production of nitric oxide (NO) by inducible nitric oxide synthase (iNOS) after exposure to simulated microgravity suggest that increased iNOS expression contributes to OH in persons with SCI. To test this possibility, male Wistar rats underwent surgical transection of the spinal cord (T10) or sham-SCI surgery followed by euthanasia 3, 7 or 14 days later. Expression in thoracic aortic of inducible (iNOS), endothelial (eNOS) and neuronal (nNOS) NOS was then determined...
March 30, 2007: Neuroscience Letters
Lucian Panait, Ronald C Merrell, Azhar Rafiq, Stanley J Dudrick, Timothy J Broderick
BACKGROUND: The objective of the study was to assess if performance of basic laparoscopic skills on a virtual reality (VR) simulator is impaired in microgravity relative to normal gravitational influences. MATERIALS AND METHODS: Fourteen subjects with various educational backgrounds underwent basic laparoscopy skill training for five consecutive days on the ground before flying aboard NASA's KC-135 zero-gravity laboratory. The participants performed basic laparoscopic exercises (clip applying, grasping, cutting, and suturing) on a VR laparoscopy simulator, both on the ground and during 25-s microgravity windows in parabolic flight...
December 2006: Journal of Surgical Research
Azhar Rafiq, Russ Hummel, Vladimir Lavrentyev, William Derry, David Williams, Ronald C Merrell
INTRODUCTION: The health provider on a space exploration mission cannot evacuate a patient to Earth. Contingency plans for medical intervention must be designed for autonomy. This study measured the effect of microgravity on performance of fine motor skills such as basic surgical tasks. METHODS: Eight subjects, six with medical and two with non-medical backgrounds, were evaluated during parabolic microgravity flights aboard NASA's KC-135. We evaluated their skill in tying surgical knots on simulated skin made of silicone using standard techniques for minimally invasive surgery...
August 2006: Aviation, Space, and Environmental Medicine
Richard T Jennings, David M F Murphy, David L Ware, Serena M Aunon, Richard E Moon, Valery V Bogomolov, Valeri V Morgun, Yuri I Voronkov, Caroline E Fife, Michael C Boyars, Randy D Ernst
BACKGROUND: Candidates for commercial spaceflight may be older than the typical astronaut and more likely to have medical problems that place them at risk during flight. Since the effects of microgravity on many medical conditions are unknown, physicians have little guidance when evaluating and certifying commercial spaceflight participants. This dynamic new era in space exploration may provide important data for evaluating medical conditions, creating appropriate medical standards, and optimizing treatment alternatives for long-duration spaceflight...
May 2006: Aviation, Space, and Environmental Medicine
John E Speich, Yvonne D Cagle, Azhar Rafiq, Ronald C Merrell, Charles R Doarn, Timothy J Broderick
INTRODUCTION: Force measurements can be used to characterize surgical maneuvers in microgravity. METHODS: : A series of surgical tasks was performed by a group of 20 participants (n=20) both in 1g on the ground and in 0 g aboard NASA's KC-135 aircraft in parabolic flight. The group included astronauts, a flight surgeon, surgeons, physicians, Ph.D.-scientists, and technical personnel. The interaction forces between the surgical instruments and the mock tissue were measured for a clip-applying, suturing, grasping, and cutting...
October 2005: Medical Engineering & Physics
Mark R Campbell, David R Williams, Jay C Buckey, Andrew W Kirkpatrick
INTRODUCTION: A surgical procedure has never been required or performed on a human in space. Parabolic microgravity simulations have suggested that surgery would be technically feasible during spaceflight. PROCEDURES: Survival surgery was performed for the first time on rats during the STS-90 Neurolab Shuttle mission. Craniotomy, leg dissection, thoracotomy, laminectomy, and laparotomy were performed as a part of physiological investigations. RESULTS: Surgical techniques successfully demonstrated in rats during spaceflight included general anesthesia, wound closure, wound healing, hemostasis, control of surgical fluids, operator restraint, and control of surgical instruments...
June 2005: Aviation, Space, and Environmental Medicine
Timothy J Broderick, Mary Beth Privitera, Scott E Parazynski, Marsh Cuttino
INTRODUCTION: 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...
April 2005: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
Azhar Rafiq, Timothy J Broderick, David R Williams, Charles R Doarn, Jeffrey A Jones, Ronald C Merrell
BACKGROUND: During spaceflight crew health is paramount in the success of flight missions. The delivery of healthcare during flight requires crew readiness for medical and surgical response. METHODS: There were 20 participants who were evaluated for accurate performance of 4 basic laparoscopic surgical skills (clip applying, cutting, grasping, and suturing) during parabolic weightlessness using an inanimate workstation aboard the NASA KC-135 aircraft. RESULTS: Data indicate that motor skill performance decreased within the parabolic microgravity flight environment...
April 2005: Aviation, Space, and Environmental Medicine
Vincent Pinsolle, Dominique Martin, Laurent de Coninck, Pierre Techoueyres, Pierre Vaïda
The aim of this experiment was to evaluate the feasibility of a microsurgical procedure in the context of microgravity during parabolic flights. The surgical procedure included the sectioning and repair of a rat sciatic nerve and tail artery with 10/0 monofilament sutures. Both procedures were successful. To date, telesurgery cannot be considered during interplanetary spaceflights. If a surgeon is able to perform microsurgery in microgravity, a physician with basic surgery training will be able to perform basic surgical procedures in space flights...
2005: Microsurgery
Lucian Panait, Timothy Broderick, Azhar Rafiq, John Speich, Charles R Doarn, Ronald C Merrell
BACKGROUND: There clearly must be a surgical capability to support the exploration of the solar system by humans. We hypothesized that microgravity would impair surgical task performance and sought to measure degree and criticality of task erosion. METHODS: Twenty subjects performed basic laparoscopic exercises (grasping, cutting, clipping, and suturing) in an inanimate trainer on the ground and during the microgravity phase of a parabolic flight. Skill assessment involved time, accuracy, and force transfer...
November 2004: American Journal of Surgery
James W Agnew, Eugene E Fibuch, John D Hubbard
Human spaceflight has evolved over the past 40 yr in pursuit of larger, more complex, and more distant missions. As this evolution continues, inevitably a spaceflight crewmember will require medical treatment involving anesthesia, either during flight or immediately upon return. If the need occurs during a deep space mission, onboard medical staff will need to be capable of surgery and anesthesia because evacuation and telemedicine will be impractical. In addition, current anesthesia techniques and procedures will have to be adapted to meet the special problems and risks that arise in administering anesthesia in space or to microgravity-exposed patients...
July 2004: Aviation, Space, and Environmental Medicine
V V Bogomolov, A D Egorov, I B Goncharov, I V Kovachevich, E N Iarmanova, I B IKozalovskaia
The authors consider factors and risk sources in long and superlong (interplanetary) missions, conceivable effects of extended exposures in microgravity, and probability of diseases in the crew. They also lay down the basic principles of medical care, including surgery, to be applied in the interplanetary mission, and propose a nomenclature of key means and equipment for the therapeutic and emergency medical care, and a configuration of a medical compartment.
2003: Aviakosmicheskaia i Ekologicheskaia Meditsina, Aerospace and Environmental Medicine
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