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Review
. 2017 Nov;30(5):339-345.
doi: 10.1055/s-0037-1606111. Epub 2017 Nov 27.

Transanal Total Mesorectal Excision: Why, When, and How

Marta Penna  1 , Christopher Cunningham  1 , Roel Hompes  2
Affiliations
Review

Transanal Total Mesorectal Excision: Why, When, and How

Marta Penna et al. Clin Colon Rectal Surg. 2017 Nov.

Abstract

Transanal total mesorectal excision (taTME) has evolved over the past decade fueled by advances in minimally invasive surgery. The technique aims to overcome the constraints posed by a narrow rigid pelvis and poor TME visualization that are encountered during "top-down" rectal surgery. A more accurate pelvic dissection should subsequently result in safer oncological resections and better preservation of pelvic autonomic nerves. taTME is an advanced complex technique that requires dedicated training and experience in TME surgery. Initial results from small cohorts are promising and confirmation by randomized controlled trials is eagerly awaited.

Keywords: bottom-up; rectal cancer; total mesorectal excision; transanal.

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Conflict of interest statement

Disclosure None.

Figures

Fig. 1
Fig. 1
Five key operative steps to transanal total mesorectal excision.
Fig. 2
Fig. 2
Sagittal T2-weighted MRI through the pelvis showing the correct plane of dissection (dashed line) that follows an acute angle backward along the sacral curvature. The dotted line shows an incorrect plan for TME surgery that would result in the mesorectum not being excised. MRI, magnetic resonance imaging; TME, total mesorectal excision.
See this image and copyright information in PMC

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