Splash down off Key Largo – Canadian doctor leads pilot telerobotic assisted surgery program for NASA Extreme Environment Mission operation

“AESOP move in.” St. Joseph’s Healthcare Hamilton surgeon Dr. Mehran Anvari, who is world renowned for his expertise in telerobotic assisted surgery, wanted a closer view of what was happening 1600 miles away and 62 feet underwater off the Florida coast.

The founding director of McMaster University’s Centre for Minimal Access Surgery at St. Joseph’s Healthcare was the lead investigator of an 11-day experiment in remote robotic telesurgery and space analog maneuvers that recently took place in the National Oceanic and Atmospheric Administration’s undersea habitat Aquarius.

In cooperation with NASA and the Canadian Space Agency, a six-member habitat crew aided by Dr. Anvari in Canada tested the feasibility of astronauts on the International Space Station or during deep space travel performing remote diagnoses and surgery. NEEMO 7 – NASA Extreme Environment Mission Operation – evaluated whether telementoring and telerobotic assisted surgery will allow a remote surgeon to guide even a non-physician to perform a complex operation.

“About a year and a-half ago we showed that we were able to perform distant surgery using robotics,” says Dr. Anvari, “and at that time we were approached by NASA and the U.S. military about using these technologies to provide care in extreme environments. We said yes.”

The robotic system with its three arms that is normally used in these kinds of operations proved to be too bulky and too sensitive to be ‘splashed down’ to the undersea lab. The technology was modified to fit into the minimal space of the habitat.

“In this mission we used robotic assisted telementoring where I guide the astronauts to perform the surgery. This time around, I only used one robotic arm. AESOP, a specially designed optical tube, connected to a medical video camera and light source, is introduced into the body in order to view the operation on a video monitor. It provides the view and I can control the robot by my voice,” said Anvari. “Using the experience from this mission, we hope to develop robotic arms which will be able to operate in such extreme environments.”

NASA astronauts Bob Thirsk, Mike Barratt and Cady Coleman, as well as Dr. Craig McKinley, who worked with Anvari on the world’s first hospital-to-hospital long distance surgery, were joined by engineers James Talacek and Ross Hein of the University of North Carolina at Wilmington on NEEMO 7.

They communicated with mission control in Key Largo, Fla., about nine miles away, via videocams over a secure, wireless point-to-point network. A high-grade, multiprotocol-label-switching virtual private network connected them with Anvari in his telerobotics lab in Hamilton.

Cady Coleman is a Lt. Col. in the American Air Force and holds a Ph.D. in engineering. She holds the rare distinction of being both an astronaut and an aquanaut, but she is not a medical doctor. On day three of the mission, Dr. Anvari walked her through performing her first operation Ñ a gallbladder surgery on a simulated body like those used by medical students.

Anvari said, “…she did it beautifully. It’s vindication of the fact that telementoring combined with some robotics can already allow a non-physician to perform emergency surgeries if necessary.”

The astronauts were also guided to use ultrasound equipment to make diagnoses and ultrasound guided interventional procedures. Ultrasound visualization for the gallbladder, common hepatic duct, pancreas and kidney were performed. They were also talked through the ultrasound detection of an abscess and then guided in draining it.

Dr. Julian Dobranowski, chief of Diagnostic Imaging at St. Joseph’s Healthcare was co-investigator in the mission. He and his team worked creatively to produce an amazing manual and CD to help train the crew and to lead them through the procedures. “New ultrasound technology is portable and sturdy. Everything ran smoothly. There were no glitches of any sort. The mission crew were particularly pleased with the manual we created for them. It was really exciting. We were able to telementor a non-medical person to do a medical procedure under close observation.”

The development of kidney stones is one of the potential dangers of deep space travel and St. Joseph’s urologist and transplant expert Dr. Anil Kapoor, mentored the Aquarius crew through the procedure to remove them.

Educational outreach is an important part of the mission. Canadian Astronaut/aquanaut Dr. Dave Williams was in Hamilton to lead kids from local schools through an uplink with the Aquarius crew. The 8th graders got a peek inside Aquarius and a chance to ask questions of the astronauts.

“I think an educational element is one of the critical parts of the mission,” said Dr. Williams. “Part of the message is about new technology and the exciting research we’re doing, but part of that message is also sharing it with the next generation of Canadians. These kids are the engineers, the researchers, and the doctors of the future who are going to be developing the technology that we can only imagine right now. As astronauts we get to do amazing things, but working with the kids is one of the most exciting things.”

Dr. Williams also presented to 450 medical students at Queen’s University. Dr. Anvari and the crew off Key Largo were linked to Kingston to participate. The students were enthralled and inspired by the opportunity to see cutting edge science, technology, and medicine working together.

NASA may be aiming high to be able to care for space travelers, but Dr. Anvari sees the mission as a first step toward providing faster medical care to patients at accident scenes or in remote parts of Canada.

“We want to explore where it might be possible to take telerobotics. I think some of the technology we’re developing will allow us to provide care to the patient wherever they are. Whether they are in a space station or in their home in Ancaster or at some remote spot in the Yukon, we are looking at providing care where the patient is and not where the doctor is.”