By Elizabeth Raymer

If scientists can put a man on the moon, or send him into space for a few years at time, can they enable astronauts to perform complex surgical procedures there, too?

Professor Adam Dubrowksi of surgery doesn't see why not, and he's making space surgery a focus of his research. There'll be a need for it once astronauts in the International Space Station begin to stay on board for extended periods, says Dubrowski, who is also a kinesiologist in the Surgical Skills Centre at Mount Sinai Hospital. The U.S. National Aeronautics and Space Administration (NASA) and the Canadian Space Agency (CSA) are also looking towards a mission to Mars, a journey that will take three to four years each way.

"The longer you stay, the more potential there is for things to happen," Dubrowski points out, noting that lacerations and trauma injuries are certainly possible. Currently, astronauts get a few hours of medical training on the ground, which is insufficient for treating more serious injuries, he says. Although typically a medical doctor is on board the space station, "everybody has to know a bit of everything." On longer missions, he anticipates having a physician and a highly skilled medical assistant who are both trained in surgery, while the rest of the crew will be trained in the basics.

Currently, emergencies are dealt with on board the space station and surgery can be performed using a remote-controlled robot. But as spaceships get further away from Earth, robotic surgery is no longer possible because the signals take longer to reach the mission, Dubrowski explains. And "no one understands what happens when you're in zero gravity" and need to suture or staple a wounded person.

So Dubrowski, his wife, Waterloo kinesiology professor Heather Carnahan, and Dr. Gary Gray, a Canadian Space Agency consultant from Defence Research and Development Canada, hope to explore these questions with CSA funding. The three have already conducted zero-gravity research into basic motor skills such as touching one's nose or tying one's shoes. A weightless environment affects a person's hand-eye co-ordination, aim and ability to apply a certain amount of force when undertaking tasks, he says. Dubrowski's interest in space research began after he received his PhD in kinesiology in 2001 from the University of Waterloo. A native of Poland who immigrated to the Toronto area, Dubrowski was influenced by a visit to Dr. Otmar Bock, a leading German researcher in zero-gravity, following completion of his doctoral studies. The two maintained a collaboration, which helped Dubrowski get funding from the European Space Agency and the German Space Agency.

Now, the Canadian Space Agency plans to develop a surgery training protocol for astronauts and Dubrowski, Carnahan and Gray -- with the support of the experts from the Surgical Skills Centre and the Wilson Centre -- plan to bid for the contract. At the same time, they will be applying for smaller funds for parabolic flight research.

Space-surgery training will be three-pronged, Dubrowski explains. The first step is adaptation to zero gravity using an inverted paradigm in which experimental participants are placed upside down on something similar to a bed to "get more of an idea of weightlessness."

The second step will be simulating zero gravity in a swimming pool; Dubrowski and Surgical Skills Centre manager Lisa Satterthwaite are working on procuring something similar to the huge swimming pool with the replica of the space station used in the NASA centre in Houston. "You can adjust the buoyancy of the person so they're suspended in water," Dubrowski says. "That's another way of simulating zero gravity."

Third, trainees will take their basic surgery skills on parabolic flights in which an airplane ascends and descends roughly 40 times, creating a transient zero-gravity environment on the descents. Dubrowski uses a variety of simple and complex simulators to allow students at the Surgical Skills Centre to practise skills such as stitching with skin patches.

Surgery in space isn't that far away, Dubrowksi predicts; there are plans to put a manned lunar base on the moon in the next five to 10 years, which will necessitate better surgical skills for the longer missions. And the sooner the better, he says.