Tips and Tricks

Abstract

The role of transanal total mesorectal excision (taTME) in minimally invasive proctectomy, especially rectal cancer surgery, is increasing. There has been exponential growth in uptake from the initial in vivo case in 2010 to the present day. Early adopters of taTME are well within the mature portions of their learning curve, but there are a significant number of novice taTME surgeons. We have overviewed the critical aspects of patient selection, operating room set-up, and necessary equipment. In particular, we recommend that a one-team approach is used for the early cases, and ideally with an experienced proctor. The important technical pearls that will aid the novice taTME surgeon were also described.

Keywords

transanal total mesorectal excision - rectal cancer - patient selection - operating room set up - equipment - one-team approach - pearls

• References

• 1 Penna M, Hompes R, Arnold S. , et al; TaTME Registry Collaborative. Transanal total mesorectal excision: international registry results of the first 720 cases. Ann Surg 2017; 266 (01) 111-117
• 2 Atallah S, Albert M, Monson JR. Critical concepts and important anatomic landmarks encountered during transanal total mesorectal excision (taTME): toward the mastery of a new operation for rectal cancer surgery. Tech Coloproctol 2016; 20 (07) 483-494
• 3 Atallah S, Albert M. The neurovascular bundle of Walsh and other anatomic considerations crucial in preventing urethral injury in males undergoing transanal total mesorectal excision. Tech Coloproctol 2016; 20 (06) 411-412
• 4 Atallah SB, DuBose AC, Burke JP. , et al. Uptake of transanal total mesorectal excision in North America: initial assessment of a structured training program and the experience of delegate surgeons. Dis Colon Rectum 2017; 60 (10) 1023-1031
• 5 Francis N, Penna M, Mackenzie H, Carter F, Hompes R. ; International TaTME Educational Collaborative Group. Consensus on structured training curriculum for transanal total mesorectal excision (TaTME). Surg Endosc 2017; 31 (07) 2711-2719
• 6 Penna M, Hompes R, Mackenzie H, Carter F, Francis NK. First international training and assessment consensus workshop on transanal total mesorectal excision (taTME). Tech Coloproctol 2016; 20 (06) 343-352
• 7 Arroyave MC, DeLacy FB, Lacy AM. Transanal total mesorectal excision (TaTME) for rectal cancer: step by step description of the surgical technique for a two-teams approach. Eur J Surg Oncol 2017; 43 (02) 502-505
• 8 Kanso F, Maggiori L, Debove C, Chau A, Ferron M, Panis Y. Perineal or abdominal approach first during intersphincteric resection for low rectal cancer: which is the best strategy?. Dis Colon Rectum 2015; 58 (07) 637-644
• 9 Lee L, Edwards K, Hunter IA. , et al. Quality of local excision for rectal neoplasms using transanal endoscopic microsurgery versus transanal minimally invasive surgery: a multi-institutional matched analysis. Dis Colon Rectum 2017; 60 (09) 928-935
• 10 Maslekar S, Pillinger SH, Sharma A, Taylor A, Monson JR. Cost analysis of transanal endoscopic microsurgery for rectal tumours. Colorectal Dis 2007; 9 (03) 229-234
• 11 Atallah S, Gonzalez P, Chadi S, Hompes R, Knol J. Operative vectors, anatomic distortion, fluid dynamics and the inherent effects of pneumatic insufflation encountered during transanal total mesorectal excision. Tech Coloproctol 2017; 21 (10) 783-794
• 12 Bernardi MP, Bloemendaal AL, Albert M, Whiteford M, Stevenson AR, Hompes R. Transanal total mesorectal excision: dissection tips using ‘O's and ’triangles'. Tech Coloproctol 2016; 20 (11) 775-778
• 13 Lee L, Abou-Khalil M, Liberman S, Boutros M, Fried GM, Feldman LS. Incidence of incisional hernia in the specimen extraction site for laparoscopic colorectal surgery: systematic review and meta-analysis. Surg Endosc 2017; 31 (12) 5083-5093
• 14 Brown CJ, Fenech DS, McLeod RS. Reconstructive techniques after rectal resection for rectal cancer. Cochrane Database Syst Rev 2008; (02) CD006040