TaTME: Present and Future Perspectives?

Abstract

Transanal total mesorectal excision (TaTME) is a new procedure developed to overcome the specific difficulties posed by rectal surgery, especially in narrow pelvis, male, and obese patients, and can be used in benign and malignant pathologies. The advantages are especially important in rectal cancer, as they could potentially result in a more precise distal dissection, lower rate of positive circumferential resection margins, and increase the rate of sphincter-sparing procedures. The indications for TaTME are currently expanding, despite not yet being standardized. Training programs are increasing day by day, to improve the learning curve related to this difficult technique. The procedure is feasible and safe with similar intraoperative complications and readmission rates compared with open/laparoscopic approach. Oncological results have shown that TaTME is associated with better quality mesorectal excision and safer distal resection margin. In this work, we review the evolution of TaTME, surgical technique, development, applicability, current situation, and implementation, as well as future perspectives for colorectal cancer and other pathologies. While satisfactory short-term results have been reported, it is a new technique, and long-term results and definitive results from controlled trials are pending. As evidence of safety and feasibility accumulates, training programs structured to standardize teaching, training, and safe expansion will aid the safe spread of TaTME.

Intraoperative Laparoscopic Fixation Sutures to Prevent Neorectal Prolapse after Transanal Total Mesorectal Excision

“…T ransanal total mesorectal excision (taTME) is a technically challenging procedure to treat lower and midrectal cancers that allows for better access to the dissection planes of the distal rectum, improving resection quality and decreasing the permanent stoma rate. 1,2 However, some complications particular to this technique are now emerging. [3][4][5] Due to the distal and extensive pelvic dissection and the need for a redundant colon to perform a very low coloanal anastomosis, the neorectal mucosa sometimes proliferates.…”