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Review
. 2020 May;33(3):168-172.
doi: 10.1055/s-0039-3402779. Epub 2020 Apr 28.

Learning Transanal Total Mesorectal Excision

Elisabeth C McLemore  1 , Peyman Lavi  1 , Vikram Attaluri  1
Affiliations
Review

Learning Transanal Total Mesorectal Excision

Elisabeth C McLemore et al. Clin Colon Rectal Surg. 2020 May.

Abstract

A dynamic evolution is occurring in transanal surgery. Transanal techniques began with intraluminal surgical removal of rectal masses and have progressed to transanal total mesorectal excision (taTME) for rectal cancer. TaTME was first performed in 2009 by Sylla, Rattner, Delgado, and Lacy. This article documents the training pathway followed by pioneers in the taTME technique as well as consensus reports outlining the process of learning the taTME technique. A literature search was performed for taTME training, learning, and technique. Key elements in learning the taTME technique include appropriate indications, cadaver training, and outcomes reporting such as participating in a taTME registry. Consensus reports also agree on the following facets associated with improved outcomes: (1) appropriate case selection of mid and low rectal cancers, (2) prerequisite completion of an accredited training program in laparoscopic colorectal surgery and prior experience in transanal endoscopic surgery, (3) a two-team taTME approach from above and below is ideal, and (4) higher rectal cancer volume surgical practice. The unifying international recommendation for surgeons interested in learning the taTME technique conveys the following message: taTME is an advanced and complex technique that requires dedicated training and experience in TME surgery.

Keywords: rectal cancer; taTME; total mesorectal excision; training; transanal.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Seven elements consistently highlighted throughout the published manuscripts to date reviewing the process of learning transanal total mesorectal excision (taTME). TEO, transanal endoscopic operation; TAMIS, transanal minimally invasive surgery.
See this image and copyright information in PMC

References

    1. Heald R J. The ‘Holy Plane’ of rectal surgery. J R Soc Med. 1988;81(09):503–508. - PMC - PubMed
    1. Rea J D, Cone M M, Diggs B S, Deveney K E, Lu K C, Herzig D O. Utilization of laparoscopic colectomy in the United States before and after the clinical outcomes of surgical therapy study group trial. Ann Surg. 2011;254(02):281–288. - PubMed
    1. Marks G J, Marks J H, Mohiuddin M, Brady L. Radical Sphincter preservation surgery with coloanal anastomosis following high-dose external irradiation for the very low lying rectal cancer. Recent Results Cancer Res. 1998;146:161–174. - PubMed
    1. Marks J, Mizrahi B, Dalane S, Nweze I, Marks G. Laparoscopic transanal abdominal transanal resection with sphincter preservation for rectal cancer in the distal 3 cm of the rectum after neoadjuvant therapy. Surg Endosc. 2010;24(11):2700–2707. - PubMed
    1. Buess G, Theiss R, Hutterer F et al.Die transanale endoskopische Rektumoperation - Erprobung einer neuen Methode im Tierversuch. Leber Magen Darm. 1983;13(02):73–77. - PubMed