title: The quest for precision in transanal total mesorectal excision.
abstract: Transanal total mesorectal excision (TME) is an emerging minimally invasive approach to rectal cancer, with encouraging preliminary results. However, the new surgical anatomy of the bottom-up approach complicates surgical understanding and increases the risks of inadvertent injuries to crucial anatomical structures, including nerves. Key elements to improve the safety and stimulate interest in such a complex technique might be robotics and image guidance, to enhance the level of precision. In this editorial, some of the technologies that could be used for precision TME are outlined, in light of the experience of our Institute for Image-Guided Surgery.
authors.affiliation: IRCAD Latina America, Hospital de Cancer de Barretos, Barretos, Brazil.
authors.forename: A G
authors.initials: AG
authors.lastname: Franchini Melani
authors.affiliation: Research Institute Against Digestive Cancer (IRCAD), 1 Place de l'Hôpital, 67091, Strasbourg, France.|Institute for Image-Guided Surgery (IHU-Strasbourg), Strasbourg, France.
authors.forename: M
authors.initials: M
authors.lastname: Diana
authors.affiliation: Research Institute Against Digestive Cancer (IRCAD), 1 Place de l'Hôpital, 67091, Strasbourg, France. jacques.marescaux@ircad.fr.|Institute for Image-Guided Surgery (IHU-Strasbourg), Strasbourg, France. jacques.marescaux@ircad.fr.
authors.forename: J
authors.initials: J
authors.lastname: Marescaux
mesh_terms: D001003:Anal Canal / Q000601:surgery; D003082:Colectomy / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008488:Medical Illustration; D057285:Precision Medicine / Q000379:methods*; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000379:methods; D000067368:Transanal Endoscopic Surgery / Q000379:methods*
keywords: Augmented reality; Confocal endomicroscopy; Diffusion tensor imaging; Fluorescence-guided surgery; Image-guided surgery; NOTES; Natural orifice transluminal endoscopic surgery; Tractography; Transanal total mesorectal excision; Virtual reality