Abstract
The Martian Chronicles: Remotely Guided Diagnosis and Treatment in the Arctic Circle
The authors of this article simulated a laparoscopic appendectomy by a novice operator who relied on telemedicine. As stated in this article, it is not an unrealistic expectation to require surgical intervention in a remote environment such as Antarctica or during space travel. For instance, a Russian doctor has performed an appendectomy on himself during an Antarctic expedition. 1
In this “proof of concept” paper, the authors simulated 2 very remote telemedicine scenarios: communication with a care provider on the moon during an ultrasound assisted evaluation of abdominal pain in a patient, and communication with a provider on Mars during a laparoscopic appendectomy. These communication distances were modeled with a delay of 2 seconds to the moon and 15 minutes to Mars. A nonradiologist, nonsurgeon stationed at Devon Island in the high Arctic performed the ultrasound and the surgical procedure with remote guidance by a surgeon at Henry Ford Hospital in Detroit, Michigan.
The operator, who was not trained in ultrasound, watched a remotely transmitted 5-minute prerecorded training video. Afterwards, a remote expert helped the operator to visualize the appendix, ovaries, and uterus, taking 20 minutes. A plastic model of the cecum and appendix was placed inside of an opaque box in order to simulate a laparoscopic appendectomy. Video instructions and diagrams were transmitted to the operator. Then, the operator executed the procedure, stopping at detailed holding points such as visualization of the appendix, confirmation of transection points, or closing the abdominal wound. At these holding points, procedural video was transmitted back to the surgeon for approval, feedback, and permission to proceed further. After 2.5 hours the procedure was completed and successful in the observing physician's estimation. Though this report only simulated a portion of the diagnosis and treatment of a surgical emergency, it does demonstrate that the technology exists to augment patient care in a remote environment.
(Surg Endosc. 2010;EPub) C Otto, JM Comtois, A Sargsyan, et al.
Prepared by Anil Menon, MD, UTMB/NASA Aerospace Medicine Fellow, Galveston, TX, USA