Surgery for interplanetary space missions — the role of interventional radiology

Correspondence to: Daniel Bister (email: dxb773@med.miami.edu)

University of Miami Miller School of Medicine

Miami

Florida

USA

BJS, https://doi.org/10.1093/bjs/znag005, published 13 March 2026

Khanna et al.1 provide a comprehensive review of surgical considerations for interplanetary space missions. They do not address the role of interventional radiology (IR), which offers advantages under many of the surgical constraints emphasized and has therapeutic overlap with several high-risk conditions identified.

IR operates well within the spaceflight constraints discussed.1 Most IR procedures require only local anesthesia and moderate sedation, and percutaneous approaches shorten recovery time without opening body cavities, addressing the anesthesia, wound healing, and fluid-containment concerns. Naïve operators have successfully performed ultrasound-guided percutaneous drainage on phantom models under remote telementoring.2 The Autonomous Medical Officer Support platform recently enabled astronauts to perform ultrasound maneuvers using autonomous in-flight guidance without ground support.3 Although early, these findings point towards the feasibility of teaching image-guided procedural skills to non-specialist operators with just-in-time support and minimal infrastructure. The International Space Station is already equipped with ultrasound equipment and intravenous access kits; basic IR capability would require a lower SWaP footprint than the surgical systems described.1 A dedicated IR toolbox for space missions has been proposed.4

Several conditions that rank highly for evacuation or loss of crew life in NASA’s Integrated Medical Model are routinely managed on Earth with image-guided percutaneous interventions.5 Obstructing nephrolithiasis, a leading driver of evacuation, can be decompressed with percutaneous nephrostomy under ultrasound guidance alone. Sepsis, the leading driver of crew death in the model,5 is frequently managed with image-guided percutaneous drainage in the setting of a drainable source. Acute cholecystitis and diverticulitis are similarly managed with percutaneous drainage. These interventions can stabilize an astronaut in transit and, with appropriate medical therapy, may allow return to duty as opposed to immediate evacuation.

Thus, IR’s advantages under surgical constraints and the therapeutic overlap with projected emergencies merits its inclusion in the interplanetary procedural-readiness framework.