The future of surgery in space exploration

Long-duration human space missions expose astronauts to microgravity, creating unprecedented surgical risks in environments where evacuation is impossible and communication delays limit real-time intervention. Understanding the feasibility and requirements of robot-assisted surgery in space is essential to ensure crew survival and mission continuity. A literature review was conducted using PubMed, Scopus, and aerospace medicine databases. Studies on surgical risks in spaceflight, robotic and tele-operated surgical systems, and translational applications were identified and thematically synthesized. Microgravity-induced physiological changes complicate surgical management. Anticipated emergencies include intra-abdominal pathologies, trauma, and craniofacial injuries. Miniaturized robotic systems with tele-mentored and semi-autonomous capabilities demonstrated feasibility in simulated and orbital environments, addressing constraints related to latency, sterility, and limited crew expertise. Translational applications include improved surgical access in remote, military, and low-resource settings on Earth. However, challenges remain in system reliability, training, ethics, and resource constraints. Robotic-assisted surgery represents a mission-critical capability for deep-space exploration and transformation for terrestrial surgical care. Integrated technological, training, and ethical frameworks are required to ensure safe tele-operated surgical interventions in extreme environments, improving global equity in surgical care.