Should SAGES advance minimally invasive surgery in space

With the recent completion of the Space Shuttle program, the National Aeronautics and Space Administration (NASA) and the rest of the American spaceflight community are designing new ways to reach space. Confusion in the popular press had led to the misconception that the Obama administration has ended the American human spaceflight program. In fact, the Obama administration (through the US Human Spaceflight Plans Committee or ‘‘Augustine Commission’’ [1]) realized that NASA did not have enough resources to both operate the space shuttle and design and build the next generation of space vehicles needed to accomplish the goals of the Bush administration’s 2004 Vision For Space Exploration [2]. So, while work on mission design and decisions about whether future space vehicles will be made by NASA or private industry progress, the US Space Program will purchase seats on Russian Soyuz vehicles for transport to and from the International Space Station. Regardless of the final design and system chosen, the crew selected to fly in space will have medical concerns. If the mission is to Mars or a near-Earth object (NEO), where the total mission time can be 3 years or longer, those medical concerns will have surgical implications that need to be addressed in-flight to complete the mission, or simply to get everyone back to Earth. According to NASA, preventive medicine is the key approach to preventing a mission-impacting medical issue, but even the best screening only reduces risk; it does not eliminate it. Also, a goal of space exploration is to allow humans to live and work in space for the long term. Over the last two decades, the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) has promoted the research and clinical adaptation of many technologies such as endoscopy, laparoscopy, robotic surgery, and natural orifice translumenal endoscopic surgery (NOTES). Besides publishing a few articles dealing with research in parabolic aircraft (also known as the ‘‘vomit comet,’’ Fig. 1) and remote environments, SAGES has done little to be involved in the next frontier of surgical practice. Is it time to rethink our focus? Browning said that our ‘‘reach should exceed [our] grasp, or what’s a heaven for?’’ [3]. SAGES should use exploration of the heavens to extend the reach of surgical technology beyond what we can currently grasp. NASA’s latest reference mission to Mars would take about 3 years; there would be about 6–8 months of transit time to Mars, 18 months on Mars, and 6–8 months to return. With a well-selected prescreened crew, the types of medical and surgical issues considered for contingency planning would be trauma from accidents and typical renal and abdominal pathologies for healthy 30–55-year-old men and women at risk for dehydration (from the low-pressure, low-humidity flight environment), fluid shifts (from weightlessness), and bone and muscle loss (disuse atrophy) [4]. The current protocol for the International Space Station is to return the crew-member to Earth for treatment as soon as safety allows for anything more than a minor medical issue. This would not be an option for a Mars mission, and even a Moon mission would have much more limited return capability. D. M. Buckland (&) D. B. Jones Harvard Medical School, Boston, MA, USA e-mail: buckland@mit.edu