Diagnostic Remote Guidance on Mars (Abstract)

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 seconds to the international space station (ISS), a potential Mars mission would necessitate time delays of about 15 minutes.  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-minute 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 international space station.

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.

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.  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.

Telementoring Abstract

Existing methods for remote guidance or mentoring of laparoscopic procedures is resource and capital intensive.   With the intention of establishing a practical and cost-effective method of providing remote intraoperative consultation, we describe the design and operation of a highly versatile telecommunications system for the purpose of mentoring clinicians while improving patient safety.  We wanted to leverage increasingly ubiquitous resource:  the physician personal digital assistants (PDA).

We identified the critical maneuver during a laparoscopic cholecystectomy, as the identification and division of the cystic duct. Consequently, we captured a short video segment of this decisive stage of the surgery, during multiple subsequent Cholecystectomies.  Video was captured from laparoscopic camera input and sent via DVI2USB Solo frame grabber to a video recording application on laptop. Seven-second video clips of the presumed cystic duct were recorded, converted, and emailed to physician consultants on their PDAs: Blackberry(R), Apple iPhone, and PlayStation(R) Portable devices.

We were able to successfully transmit three video clips to to all three devices and present them to expert physicians, each of whom believed consulting advice could be offered based on the image quality.
Although formal validity has yet to be established, this represents proof-of-concept.  We succeeded in establishing a reproducible method of accurately transmitting sufficient video for telementoring and pursuit of increased patient safety utilizing primarily existing infrastructure.