Have we done surgery in space?

Chris Smith put this question from Jim to space doctor Christina Mackaill...

Christina - So this is a really hot topic at the moment. For missions to Mars and things like that. So on the space station it'd be too risky. We wouldn't do surgery in space because we have the option to evacuate and bring them back home. For example if someone had an appendicitis it's a great example and it's a hot topic and so we would start with antibiotics. We could use the ultrasound machine to sort of assess the severity but ultimately we could bring them home. When it comes to Mars, we are six months away from Mars when Earth and Mars are at their closest. Anything could happen on the way there and anything could happen whilst you’re there. So we do need surgical capability in microgravity on the way there and once we're there. The thing is with surgery in space; fluids, obviously in microgravity that's a danger. Blood's in body fluids floating around and contaminating the ISS, wound healing is also slower in space. And you know, we just don't have the same resources as we do on Earth if things went wrong. So really interesting sort of debate about this is should we prophylactically remove people's appendixes and gall bladders you know the non essentials.

Chris - Surely not, surely not!

Christina - No, you know is there now is a really interesting debate because you have to weigh up the complications that could occur in space versus the complications of, you know, surgery here. But it's leaning more towards not doing it because there's ethics around it and also post-op complications. And then the probability of it even happening and then we have antibiotics which could obviously maybe cure it anyway so I think they're leaning more towards not removing it but it's an interesting debate.

Chris - The other thing that's foremost in my mind is the infection control implications of doing surgery in space because you chop into somebody you're going to create this aerosol sort of spray if you like, of body fluids and blood. Now when we do this as an operating theatre, gravity intervenes and it all runs off the table onto the floor and onto the surgeon's feet and then you can clean the shoes off and everyone's a winner. But you do that in space, everyone's going to be breathing in bits of you.

Christina - Yeah that's what I mentioned earlier about fluids floating around and stuff like that. So I know they are developing surgical workstations and they're having to take these things into account like watertight vacuums and things like that. And again your immune system sort of dwindles a little bit in space as well. So there's so many things to consider but ultimately, the answer’s yes, where we need to be prepared for surgery

Chris - We're going to have to go there. One wonders though, because you've injured yourself I see with your skiing exploits, you've got your left arm in a sling. What was what was the cause of that?

Christina - Not being very good at snowboarding. Essentially the answer to that question.

Chris - Snowboarding’s got a lot to answer for hasn't it, because the last person, the last guest we had on the programme was the Regius Professor of Botany from the University of Glasgow and he’d broken both of his legs in Chamonix.

Christina - That's where I was this was!

Chris - Must be a bad year for it. But you think often treating people who've had orthopaedic type injuries is a big headache because of weight bearing, whereas in space I suppose there might be a benefit actually, to fixing broken things because people wouldn't have to put weight on them when they're at their most painful.

Christina - Well actually I was reading something about this and it's hypothesised that bone healing from say a fracture actually might be a bit slower in space because we don't have mechanical loading and then we don't have cartilage formation. They're doing a lot of research into that as well because you know the bones become weaker in space, they are susceptible to fracture but actually it may not heal as well either because you don't have the weight of gravity to load and rebuild the cartilage

Chris - So it’d be less painful but a less good healing outcome.

Christina - Yeah exactly yeah.