Pittsburgh researchers prepare for space surgery

Device could restrain body fluids in tricky zero-gravity operations

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Before humans can take long expeditions to Mars and beyond, and even back and forth to the moon, one problem must be solved.

In the weightlessness of space, an appendectomy, removal of a gall bladder, cuts or wounds, or even the pulling of a tooth would contaminate the spaceship with blood, tissue and bodily fluids. Gravity, as it turns out, is an important surgical tool that helps to confine bodily fluids.

But a team of local researchers is working to solve the problem. Its astro-surgical tool, known as an Aqueous Immersion Surgical System, uses water pressure in a watertight containment area to control bleeding and prevent blood, fluids and tissue from floating away. With no blood bank available in space, the device also could recover an astronaut's blood during surgery for reuse in the patient.

James E. Burgess, a neurosurgeon at Allegheny General Hospital; James Antaki, a biomedical engineer at Carnegie Mellon University; doctoral student Jennifer A. Hayden; and George M. Pantalos, a professor of biomedical engineering and surgery at the University of Louisville, are combining talents and expertise to refine a prototype initially designed to control blood during brain and spinal surgeries. Only later did they realize the idea provided a solution of conducting surgeries in space.

Here's the basic concept: A clear dome without a bottom is attached watertight to the skin, creating a seal similar to wearing swim goggles. The dome includes tubes and controls to add pressure from a sterile saline solution to control bleeding or flush the solution away if it turns cloudy from blood or bodily fluids. In that way, the surgeon's view is preserved while added pressure controls bleeding, much like gauze packed into a wound.

The device also includes watertight ports through which surgical instruments are used to do the surgery beneath the dome. Open surgery, laparoscopic or arthroscopic surgeries, or even the stitching of wounds would be possible with the system, the researchers said.

Inside spacecraft, a larger clear container with arm ports for the surgeon would be used over the smaller dome to provide a backup should the domed device fail.

About 2003, Dr. Burgess came up with the idea to develop a watertight surgery system to control bleeding during brain and spinal surgeries. He said ruptured vessels can make it difficult to control bleeding or have a clear view of the surgical site.

Needing help with the engineering, he approached Mr. Antaki with the idea. They began work on a prototype, but Mr. Antaki was unable to land National Institutes of Health grants for the project. He said NIH officials found the idea to be "innovative beyond the point of feasibility."

"Inventors love their inventions and think they are great," said Mr. Antaki, who holds a doctoral degree in biomedical engineering. "But convincing skeptics and others is not as easy."

After a string of NIH rejections, he searched a list of government agencies that awarded small-business grants, and his eyes landed on NASA. It almost was a eureka moment.

"I realized that in outer space, zero gravity was a bigger problem, so let's pursue a NASA grant," he said. "In my humble opinion, I think [the new device] is essential. I can't imagine going into space and stitching up a wound or gash or doing a tooth extraction -- anything involving blood -- without a containment system."

With that idea, Mr. Antaki contacted his friend, Mr. Pantalos, who had worked with NASA to study heart function and blood pressure during space missions and the impact that returning to Earth had on heart health. Mr. Pantalos, who also holds a doctoral degree, tested his technology aboard NASA's zero-gravity C-9 aircraft at the Johnson Space Center Reduced Gravity Program at Ellington Field, southeast of Houston.

The plane, nicknamed the "Vomit Comet," accomplishes weightlessness by a parabolic path through the sky, similar to a roller coaster, producing weightlessness during quick descents. It's not a pleasant ride for anyone prone to motion sickness.

In the meantime, Mr. Antaki received an application from Ms. Hayden, who had done research on surgical tools for Ethicon, the Johnson & Johnson company that works on surgical solutions, before deciding to seek a doctoral degree in biomedical engineering. He thought she'd be the ideal candidate to work on the project as a topic for her doctoral dissertation.

The research team is preparing to make a major step in development of the device and prove that the concept can work. The project currently has no outside funding, but NASA is offering in-kind assistance by providing research time on the zero-gravity aircraft.

On Oct. 2-5, Mr. Pantalos, Ms. Hayden and Dr. Burgess will take four flights on the aircraft to test the technology. On the final two flights, Dr. Burgess said, he plans to do surgical procedures on a pig's heart to test whether the system can contain the fluids during zero gravity.

Mr. Pantalos said he did 27 missions on the zero-gravity aircraft for his previous project. "It's great fun," he said. "It's kind of like in the movie, 'Hook,' when Peter Pan discovers that he can fly. It's a magical experience."

More research and development will be necessary as the team works to resolve all technical problems, but Mr. Antaki said the project is advancing nicely with hopes that NASA eventually will fund the project.

"I'm totally convinced that it is safe and effective," he said.

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