A new solution to some old problems: transanal TME

Heald, R. J.

doi:10.1007/s10151-013-0984-0

Cited by 159 publications

(108 citation statements)

References 7 publications

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“…As such, it has become the center point of every major colorectal conference as experienced surgeons fill auditoriums to learn everything they can about it and seek specialized course training. The prediction made by Heald [27] has come to fruition and his bold statement about transanal TME 'revolutionizing the practice of rectal cancer surgery' rings true. I would add my own prediction: that over the next 5 years, transanal TME will not only become a case integrated into colorectal fellowship training curricula, but also transanal TME will become an 'index case' with a level of importance to rival the highly coveted ileoanal pouch procedure.…”

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confidence: 99%

Transanal total mesorectal excision: full steam ahead

Atallah¹

2015

Tech Coloproctol

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The article by Araujo [1] in this month's issue documents the dramatic climb of transanal total mesorectal excision (transanal TME) with the most comprehensive review on this topic to date and a revelation of published numbers that are approximately double what they were just 1 year ago [2]. While it may seem as if transanal TME materialized overnight, in actuality, its foundation had been quietly in development for three decades. The seeming sudden ascent of transanal TME is analogous to a building under construction. Developing a proper foundation is a time-intensive and critical first step. To naïve observers of a construction site, it may appear as though no progress is underway, until the foundation is completed and suddenly a building begins to rise ten stories high, filling in the skyline with striking speed.The foundation for transanal TME began 30 years ago with the innovative efforts of Gerald Marks and later carried on with his son John Marks. In the early 1980s, G. Marks pioneered the technique of what he termed the transabdominal-transanal (TATA) operation for rectal cancers involving the distal one-third of the rectum [3], performing a meticulous dissection from below and adapting Bill Heald's concept of TME, albeit 'in reverse.' This predated the era of laparoscopy and the first TATA operations were completed with an open approach before transitioning to the use of laparoscopic assistance in the 1990s [4]. For 30 years, Marks' TATA operation laid down the foundation for modern transanal TME, spelling out very clearly why this approach was preferred for distal rectal cancer. Principally, the advantages of TATA were (a) definition of the distal margin from below, thereby assuring no tumor involvement at the line of distal division and (b) obviating the need for stapling devices for transection, which do not comply with boney constraints ofin particular-the narrow male pelvis. Even when staplers could be negotiated into pelvic confines from above, there was still the risk of inadvertently stapling across tumor, thereby irreversibly compromising the oncologic integrity of the operation. While Marks' rationale behind TATA was perfectly on point, the technique required specialized retractors with limited exposure, and thus few were able to replicate this approach.In parallel with TATA, the transanal endoscopic microsurgery (TEM) scope was developed by Buess [5] and considerable experience was gained with TEM for local excision of rectal neoplasia, though primarily for nonmalignant lesions. TEM was, for many, an unaffordable privilege of the elite; most colorectal surgeons, to this day, are not privy to TEM nor have they had formal training with this exquisite device. TEM's penetration had remained limited due to prohibitive upfront costs and also the complexity it mandates from surgeons.During a recent lectureship webcast, a renowned colorectal surgeon remarked that, 'in [the year] 2000, TEM was dead.' This statement was not intended to discredit the otherwise precocious TEM marvel. Implicit, however,...

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Transanal total mesorectal excision: full steam ahead

Atallah¹

2015

Tech Coloproctol

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“…Standard TME is performed conventionally (through open surgery), laparoscopically, and more recently by the application of robotic-assisted technology. Today, experienced surgical centers perform total mesorectal excision also through transanal approach (Transanal total Mesorectal Excision, TATME), especially for distal rectal cancer, in obese patients and in patients with narrow pelvis [12].…”

Section: Radical (Transabdominal) Operating Proceduresmentioning

confidence: 99%

Modern surgical treatment of rectal cancer

Zovak¹,

Bilic²,

Kopljar³

2017

Rad Hrvatske akademije znanosti i umjetnosti

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SummarySurgical treatment is a method of choice in treating patients with resectable primary form of rectal cancer. An important step in treatment is the multidisciplinary approach from different medical specialties in the fields of radiology, gastroenterology, oncology and surgery. In recent years, several minimally invasive surgical procedures have been developed that improve postoperative recovery while still preserving oncological principles, such as laparoscopic low anterior resection, transanal total mesorectal excision and robotic surgery. Surgical and oncological principles that must be respected in all cases are wide resection of the tumor with histologically free resection margins and the use of total mesorectal excision with anal sphincter preservation and preservation of the continuity of the intestine whenever possible.

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“…Morbidity rate was 20 % (one urethral injury, two urinary retentions, one anastomotic hemorrhage and one mild anastomotic leak). The median number of harvested lymph nodes was 12 (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. All specimens were intact in mesorectum without positive distal and circumferential resection margins.…”

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confidence: 99%