House Calls Go High Tech

Astronauts dive deep to try space surgery.

For 11 days last October, a U.S. laboratory at the bottom of the sea served as a hospital for astronauts. They weren't sick. They were testing the latest concepts in long-distance doctoring for future trips to the moon and Mars.

"Astronauts navigating between planets won't be able to turn around and come home when someone gets sick," says project manager Bill Todd of NASA's space shuttle operations contractor, United Space Alliance. Even the International Space Station, orbiting just 250 miles high, is too remote for conventional health care delivery. On the expeditions NASA envisions in the next decade, healing will be done through the old-fashioned house call-kicked up a technological notch through satellites and fiber optics.

Three astronauts tried their hands at telesurgery during a recent mission to the National Oceanic and Atmospheric Administration's Aquarius Under-water Laboratory off the coast of Key Largo, Fla. Dr. Michael Barratt, Air Force Col. Catherine "Cady" Coleman, and Dr. Robert Thirsk of Canada, wielded the scalpels. An expert in Ontario, 1,500 miles away, used two-way telecommunications links and virtual reality control technology to guide them and a robot assistant through diagnosis and surgery on six dummies. Actually, they were just torsos and abdomens, and each partial-body mannequin sacrificed a different body part for science. Thirsk, who is not a surgeon, removed a gall bladder through a sophisticated small-cut procedure called laparoscopy.

"Knowing [the expert] could see me inserting the instruments into the patient's abdomen and retracting them gave me a lot of confidence," says Thirsk. "If I had to do the procedures without him remotely looking over my shoulder, I would have been very uneasy."

Telemedicine is not new. It has been used since 1999 in Canada's far northern reaches, where Dr. Craig McKinley pioneered its use helping general practitioners operate on patients who can't travel to a metropolitan area for treatment. For doctors who practice in rural or remote settings, telemedicine offers access to the expertise they need to deliver state-of-the-art medical care. Whether the technology will permit defining "remote" as not merely terrestrial is the question. Maybe is the answer. "We've learned that the technologies that we have terrestrially are not as robust, ergonomic and affordable as they need to be to find applications extraterrestrially," says McKinley, who accompanied the astronauts on their dive.

With its physical and psychological isolation on the floor of the Atlantic Ocean, Aquarius provided the perfect extreme environment in which to validate telemedicine concepts. The yellow submarine is anchored 63 feet beneath the water's surface, in a sand patch adjacent to deep coral reefs in the Florida Keys Marine Sanctuary. Aquarius is there to support scientists who visit the reefs to study them throughout the year, but NASA uses it to teach astronauts the finer points of living and working in space.

"Except for the fact that nothing is floating around"-inside, at least-"it's incredibly similar to space," says Coleman. Instead of zero gravity as the environmental oddity, the Aquarius crews must endure two-and-a-half times the normal atmospheric pressure.

Similar in size to the International Space Station's living quarters, Aquarius is the world's only permanent underwater habitat and research laboratory. Aquarius is owned by NOAA, operated by the University of North Carolina at Wilmington, and funded by NOAA's Undersea Research Program. NASA Extreme Environment Mission Operations, or NEEMO, missions are a cooperative project between NASA, NOAA and the university.

Coleman says government managers can learn as much from the NEEMO project as medical professionals, if they consider how technology can improve the exchange of information in the course of governing. "That technology is changing every single day," she says, "and with it [comes] capabilities that have to affect the enterprises that [managers] are running, no matter what government enterprise it is."