Although no surgical procedures have been performed on humans during space flight, the risk of a problem arising that requires surgical intervention is nonetheless real. From a timeweighted standpoint, until the advent of long-duration missions in the U.S. Skylab program and the Russian Salyut and Mir programs, the probability of an in-flight problem arising that would require a surgical solution was small; thus clinical experience and expertise in performing surgery on humans in microgravity remained quite limited. The lack of on-site surgical expertise was keenly felt when Russian space program officials were faced with the possible medical evacuation of a Salyut 7 cosmonaut who was experiencing abdominal pain thought to be due to appendicitis. Although that episode turned out to have been caused by probable ureterolithiasis rather than appendicitis—the cosmonaut recovered and did not require an early return to Earth—this experience nonetheless underscored a pressing need in space flight.
With further increases in crew size and mission duration projected in the near future for the International Space Station (ISS) and the exploration-class missions that will follow, the likelihood of events occurring in space flight that will require surgery will also increase. Moreover, the probability of trauma (including penetrating trauma, lacerations, crush injuries, and thermal and electrical burns) occurring will increase as astronauts and cosmonauts conduct ISS construction-related extravehicular activities that involve manipulation of highmass hardware. A surgical need could also be precipitated by exercise countermeasures, which may lead to minor and major orthopedic injuries. Routine surgical diseases such as appendicitis and cholecystitis can occur indiscriminately at seemingly random times. The physiological changes and deconditioning effects of prolonged weightlessness will influence surgical diseases and treatment in predictable as well as unknown ways. Finally, the possibility of previously unknown surgical problems in the unexplored long-duration microgravity environment must be considered.
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Campbell, M.R., Billica, R.D. (2008). Surgical Capabilities. In: Barratt, M.R., Pool, S.L. (eds) Principles of Clinical Medicine for Space Flight. Springer, New York, NY. https://doi.org/10.1007/978-0-387-68164-1_6
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