# Surgery for interplanetary space missions

## TL;DR

This paper reviews the challenges of performing surgery in space and proposes robotic surgery as a viable solution for future interplanetary missions.

## Contribution

The paper proposes a technical framework for robotic surgery in space, emphasizing AI and human-in-the-loop control.

## Key findings

- Surgical skill is largely unaffected by reduced gravity when operator, patient, and instruments are restrained.
- Robotic surgery is a critical capability for future space missions but requires further development.
- Crew training and technical design are essential for successful space surgery.

## Abstract

As human spaceflight expands beyond low Earth orbit, the ability to deliver advanced surgical care in space becomes critical. Current medical provisions on board the International Space Station (ISS) are geared towards treating low-risk conditions, with a ‘stabilize-and-evacuate’ principle for more complex cases—an approach that is not viable for extended missions to the Moon and Mars. This review summarizes research conducted around space surgery, with a particular focus on surgical robotics. Experiments in parabolic flight and analogue environments demonstrate that, provided the operator, patient, and instruments are restrained, surgical skill is largely unaffected by reduced gravity. Robotic surgery has primarily been explored in remote undersea habitats and in limited flight studies. There are several challenges to the implementation of surgical systems in space, including size, weight, and power constraints, communication latency, and crew training. Means of fluid and debris containment, provision of anaesthesia, and postoperative recovery in altered physiology must also be considered. The key features of an ideal space surgery robotic set-up are outlined. It should be compact, multifunctional, adaptable, reliable, and optimized in technical design and material composition for use in habitable volumes. Such systems should incorporate artificial intelligence (AI)-driven decision-making support, variable autonomy, and human-in-the-loop control. Crew members must be trained and supported to deliver and recover from surgical care in space. Cloud and edge computing will mitigate latency while expanding on-board data processing capabilities. Although not yet operationally mature, robotic surgery is a critical capability for future exploratory space missions, but requires continued multidisciplinary development.

This review summarizes previous work on surgery in microgravity and proposes robotic surgery as the best solution for positive astronaut-care outcomes, with a complete technical workflow that covers the crew, robot, and environment.