Education and Training in Transanal Endoscopic Surgery and Transanal Total Mesorectal Excision

Abstract

There is a paradigm shift in surgical training, and new tool and technology are being used to facilitate mastery of the content and technical skills. The transanal procedures for rectal cancer—transanal endoscopic surgery (TES) and transanal total mesorectal excision (TaTME)—have a distinct learning curve for competence in the procedures, and require special training for familiarity with the “bottom-up” anatomy, procedural risks, and managing complex cases. These procedures have been models for structured education and training, using multimodal tools, to ensure safe implementation of TES and TaTME into clinical practice. The goal of this work was to review the current state of surgical education, the introduction and learning curve of the TES and TaTME procedures, and the established and future models for education of the transanal procedures for rectal cancer.

Understanding How Experts Do It

“…(A.C., S.O., D.P., E.P.) ultimately participated in the study [median age 41.5 years old (34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)]. The semistructured telephone interviews had a median duration, based on the recorded time, of 66 minutes (44-78).…”

“…Next, 12 international experts convened to develop prerequisites for learning, curricular structure, a global assessment scale, and consensus statements to be voted on by a larger group of experts to reach agreement. The framework was refined after a second group of experts included the safe implementation of TaTME, the pitfalls encountered by early adopters, and outcomes analysis 37. This thoughtful approach has enabled the safe progression of the TaTME from an experimental procedure to one that is taught internationally, serving as a prototype for contemporary surgical education.…”

“…The framework was refined after a second group of experts included the safe implementation of TaTME, the pitfalls encountered by early adopters, and outcomes analysis. 37 This thoughtful approach has enabled the safe progression of the TaTME from an experimental procedure to one that is taught internationally, serving as a prototype for contemporary surgical education. Similarly, Zahiri et al 38 performed a needs assessment via mixed methodology to understand the gap in herniorraphy training in surgical residency.…”