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Digestive Disease Interventions 2023; 07(01): 037-041
DOI: 10.1055/s-0042-1760370
Review Article

From Transanal Total Mesorectal Excision to Transanal Transection with Single-Stapled: Evolution of Transanal Techniques

Jacopo Crippa
2   IRCCS Humanitas Research Hospital, Division of Colon and Rectal Surgery, Milan, Italy
,
Caterina Foppa 
1   Department of Biomedical Sciences, Humanitas University, Milan, Italy
2   IRCCS Humanitas Research Hospital, Division of Colon and Rectal Surgery, Milan, Italy
,
Antonino Spinelli 
1   Department of Biomedical Sciences, Humanitas University, Milan, Italy
2   IRCCS Humanitas Research Hospital, Division of Colon and Rectal Surgery, Milan, Italy
› Author Affiliations Funding The authors have no relevant commercial or financial disclosures. No specific funding was utilized for completion of this study.
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Abstract

The last decades have seen a remarkable improvement in colorectal surgery, as new techniques and protocols have been developed and adopted. Restoring the continuity of the intestinal tract after low rectal surgery remains one unresolved challenge. The development of new transanal techniques to approach the lowest rectum paved the way for a switch in mentality. Transanal total mesorectal excision has seen a steep adoption by colorectal surgeons, combining the transanal pathway with the use of minimally invasive techniques to overcome the historical difficulties of the anterior approach. One step ahead in the evolution of the transanal approach could be represented by the recently described transanal transection with single stapled technique, developed to address the main concerns of previous transanal approaches thus providing oncological and functional balance.

Keywords

rectal surgery - transanal surgery - rectal cancer - anastomotic techniques - TaTME - TTSS


Publication History

Received: 09 September 2022

Accepted: 05 December 2022

Article published online:
17 January 2023

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  • References

  • 1 Scott N, Jackson P, al-Jaberi T, Dixon MF, Quirke P, Finan PJ. Total mesorectal excision and local recurrence: a study of tumour spread in the mesorectum distal to rectal cancer. Br J Surg 1995; 82 (08) 1031-1033
    CrossrefPubMedGoogle Scholar
  • 2 Crippa J, Grass F, Dozois EJ. et al. Robotic surgery for rectal cancer provides advantageous outcomes over laparoscopic approach: results from a large retrospective cohort. Ann Surg 2021; 274 (06) e1218-e1222
    CrossrefPubMedGoogle Scholar
  • 3 Heald RJ. A new solution to some old problems: transanal TME. Tech Coloproctol 2013; 17 (03) 257-258
    CrossrefPubMedGoogle Scholar
  • 4 Atallah S, Albert M, DeBeche-Adams T, Nassif G, Polavarapu H, Larach S. Transanal minimally invasive surgery for total mesorectal excision (TAMIS-TME): a stepwise description of the surgical technique with video demonstration. Tech Coloproctol 2013; 17 (03) 321-325
    CrossrefPubMedGoogle Scholar
  • 5 Vlug MS, Wind J, Hollmann MW. et al; LAFA Study Group. Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study). Ann Surg 2011; 254 (06) 868-875
    CrossrefPubMedGoogle Scholar
  • 6 Sylla P, Rattner DW, Delgado S, Lacy AM. NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 2010; 24 (05) 1205-1210
    CrossrefPubMedGoogle Scholar
  • 7 Hompes R, Arnold S, Warusavitarne J. Towards the safe introduction of transanal total mesorectal excision: the role of a clinical registry. Colorectal Dis 2014; 16 (07) 498-501
    CrossrefPubMedGoogle Scholar
  • 8 Deijen CL, Velthuis S, Tsai A. et al. COLOR III: a multicentre randomised clinical trial comparing transanal TME versus laparoscopic TME for mid and low rectal cancer. Surg Endosc 2016; 30 (08) 3210-3215
    CrossrefPubMedGoogle Scholar
  • 9 Roodbeen SX, Spinelli A, Bemelman WA. et al. Local recurrence after transanal total mesorectal excision for rectal cancer: a multicenter cohort study. Ann Surg 2021; 274 (02) 359-366
    CrossrefPubMedGoogle Scholar
  • 10 Vannijvel M, Wolthuis AM. Limitations and concerns with transanal total mesorectal excision for rectal cancer. Clin Colon Rectal Surg 2022; 35 (02) 141-145
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Spinelli A, Carvello M, D'Hoore A, Foppa C. Integration of transanal techniques for precise rectal transection and single-stapled anastomosis: a proof of concept study. Colorectal Dis 2019; 21 (07) 841-846
    CrossrefPubMedGoogle Scholar
  • 12 Spinelli A. The rationale for expanding transanal transection and single-stapled anastomosis from transanal total mesorectal excision to open, laparoscopic and robotic resections. Colorectal Dis 2019; 21 (09) 991
    CrossrefPubMedGoogle Scholar
  • 13 Marks G, Mohiuddin M, Rakinic J. New hope and promise for sphincter preservation in the management of cancer of the rectum. Semin Oncol 1991; 18 (04) 388-398
    PubMedGoogle Scholar
  • 14 Marks JH, Frenkel JL, D'Andrea AP, Greenleaf CE. Maximizing rectal cancer results: TEM and TATA techniques to expand sphincter preservation. Surg Oncol Clin N Am 2011; 20 (03) 501-520 , viii–ix
    CrossrefPubMedGoogle Scholar
  • 15 Buess G, Hutterer F, Theiss J, Böbel M, Isselhard W, Pichlmaier H. [A system for a transanal endoscopic rectum operation]. Chirurg 1984; 55 (10) 677-680
    PubMedGoogle Scholar
  • 16 Leong KJ, Evans J, Davies MM, Scott A, Lidder P. Transanal endoscopic surgery: past, present and future. Br J Hosp Med (Lond) 2016; 77 (07) 394-402
    CrossrefPubMedGoogle Scholar
  • 17 Berger NF, Sylla P. The role of transanal endoscopic surgery for early rectal cancer. Clin Colon Rectal Surg 2022; 35 (02) 113-121
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Perez RO, Julião GPS, Vailati BB. Transanal local excision of rectal cancer after neoadjuvant chemoradiation: Is there a place for it or should be avoided at all costs?. Clin Colon Rectal Surg 2022; 35 (02) 122-128
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Stijns RCH, de Graaf EJR, Punt CJA. et al; CARTS Study Group. Long-term oncological and functional outcomes of chemoradiotherapy followed by organ-sparing transanal endoscopic microsurgery for distal rectal cancer: the CARTS study. JAMA Surg 2019; 154 (01) 47-54
    CrossrefPubMedGoogle Scholar
  • 20 Atallah S, Albert M, Larach S. Transanal minimally invasive surgery: a giant leap forward. Surg Endosc 2010; 24 (09) 2200-2205
    CrossrefPubMedGoogle Scholar
  • 21 Kim MJ, Lee TG. Transanal minimally invasive surgery using laparoscopic instruments of the rectum: a review. World J Gastrointest Surg 2021; 13 (10) 1149-1165
    CrossrefPubMedGoogle Scholar
  • 22 Bernhardt J, Sasse S, Ludwig K, Meier PN. Update in natural orifice transluminal endoscopic surgery (NOTES). Curr Opin Gastroenterol 2017; 33 (05) 346-351
    CrossrefPubMedGoogle Scholar
  • 23 Spinelli A, Clerico G, Foppa C, Carrano FM, Carvello M. Laparoscopic intracorporeal double pursestring ileorectal anastomosis with transanal natural orifice specimen extraction. Dis Colon Rectum 2021; 64 (06) e367
    CrossrefPubMedGoogle Scholar
  • 24 Lee GC, Sylla P. Shifting paradigms in minimally invasive surgery: applications of transanal natural orifice transluminal endoscopic surgery in colorectal surgery. Clin Colon Rectal Surg 2015; 28 (03) 181-193
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Limbert M, de Almeida JM. Colorectal anastomosis after laparoscopic low anterior resection with total mesorectal excision: a difficult problem made simple. Dis Colon Rectum 2009; 52 (12) 2048-2050
    CrossrefPubMedGoogle Scholar
  • 26 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
    CrossrefPubMedGoogle Scholar
  • 27 Adamina M, Buchs NC, Penna M, Hompes R. St. Gallen Colorectal Consensus Expert Group. St. Gallen consensus on safe implementation of transanal total mesorectal excision. Surg Endosc 2018; 32 (03) 1091-1103
    CrossrefPubMedGoogle Scholar
  • 28 de Lacy FB, Keller DS, Martin-Perez B. et al. The current state of the transanal approach to the ileal pouch-anal anastomosis. Surg Endosc 2019; 33 (05) 1368-1375
    CrossrefPubMedGoogle Scholar
  • 29 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
    CrossrefPubMedGoogle Scholar
  • 30 Detering R, Roodbeen SX, van Oostendorp SE. et al; Dutch ColoRectal Cancer Audit Group. Three-year nationwide experience with transanal total mesorectal excision for rectal cancer in the Netherlands: a propensity score-matched comparison with conventional laparoscopic total mesorectal excision. J Am Coll Surg 2019; 228 (03) 235-244.e1
    CrossrefPubMedGoogle Scholar
  • 31 Di Candido F, Carvello M, Keller DS. et al. A comparative cost analysis of transanal and laparoscopic total mesorectal excision for rectal cancer. Updates Surg 2021; 73 (01) 85-91
    CrossrefPubMedGoogle Scholar
  • 32 Warren OJ, Solomon MJ. The drive toward transanal total mesorectal excision - Science or rhetoric?. Dis Colon Rectum 2015; 58 (09) 909-910
    CrossrefPubMedGoogle Scholar
  • 33 Gachabayov M, Bergamaschi R. Is TaTME delivering?. Updates Surg 2019; 71 (01) 13-15
    CrossrefPubMedGoogle Scholar
  • 34 Wasmuth HH, Faerden AE, Myklebust TA. et al; Norwegian TaTME Collaborative Group, on behalf of the Norwegian Colorectal Cancer Group. Transanal total mesorectal excision for rectal cancer has been suspended in Norway. Br J Surg 2020; 107 (01) 121-130
    CrossrefPubMedGoogle Scholar
  • 35 Spinelli A, Foppa C, Carvello M. et al. Transanal transection and single-stapled anastomosis (TTSS): a comparison of anastomotic leak rates with the double-stapled technique and with transanal total mesorectal excision (TaTME) for rectal cancer. Eur J Surg Oncol 2021; 47 (12) 3123-3129
    CrossrefPubMedGoogle Scholar
  • 36 Foppa C, Ng SC, Montorsi M, Spinelli A. Anastomotic leak in colorectal cancer patients: new insights and perspectives. Eur J Surg Oncol 2020; 46 (06) 943-954
    CrossrefPubMedGoogle Scholar
  • 37 Roumen RM, Rahusen FT, Wijnen MH, Croiset van Uchelen FA. “Dog ear” formation after double-stapled low anterior resection as a risk factor for anastomotic disruption. Dis Colon Rectum 2000; 43 (04) 522-525
    CrossrefPubMedGoogle Scholar
  • 38 Spinelli A, Foppa C, Carrano FM, Sacchi M, Carvello M. Transanal transection and single-stapled anastomosis for ileo-anal pouch surgery - a video vignette. Colorectal Dis 2021; 23 (09) 2483-2484
    CrossrefPubMedGoogle Scholar
  • 39 Foppa C, Carrano FM, Spinelli A. Functional outcomes after transanal surgery. Clin Colon Rectal Surg 2022; 35 (02) 146-154
    Article in Thieme ConnectPubMedGoogle Scholar