Surgical Endoscopy

, Volume 31, Issue 7, pp 2711–2719 | Cite as

Consensus on structured training curriculum for transanal total mesorectal excision (TaTME)

  • Nader Francis
  • Marta Penna
  • Hugh Mackenzie
  • Fiona Carter
  • Roel Hompes
  • The International TaTME Educational Collaborative Group
Consensus Statement



The interest and adoption of transanal total mesorectal excision (TaTME) is growing amongst the colorectal surgical community, but there is no clear guidance on the optimal training framework to ensure safe practice for this novel operation. The aim of this study was to establish a consensus on a detailed structured training curriculum for TaTME.


A consensus process to agree on the framework of the TaTME training curriculum was conducted, seeking views of 207 surgeons across 18 different countries, including 52 international experts in the field of TaTME. The process consisted of surveying potential learners of this technique, an international experts workshop and a final expert’s consensus to draw an agreement on essential elements of the curriculum.


Appropriate case selection was strongly recommended, and TaTME should be offered to patients with mid and low rectal cancers, but not proximal rectal cancers. Pre-requisites to learn TaTME should include completion of training and accreditation in laparoscopic colorectal surgery, with prior experience in transanal surgery. Ideally, two surgeons should undergo training together in centres with high volume for rectal cancer surgery. Mentorship and multidisciplinary training were the two most important aspects of the curriculum, which should also include online modules and simulated training for purse-string suturing. Mentors should have performed at least 20 TaTME cases and be experienced in laparoscopic training. Reviewing the specimens’ quality, clinical outcome data and entering data into a registry were recommended. Assessment should be an integral part of the curriculum using Global Assessment Scales, as formative assessment to promote learning and competency assessment tool as summative assessment.


A detailed framework for a structured TaTME training curriculum has been proposed. It encompasses various training modalities and assessment, as well as having the potential to provide quality control and future research initiatives for this novel technique.


Transanal TME Consensus Training Curriculum Assessment 



International TaTME Educational Collaborative Group: Aigner F, Albert M, Araujo SE, Arezzo A, Arnold S, Atallah S, Austin R, Biebl M, Bonjer J, Boni L, Bordeianou L, Brunner W, Cahill R, Davies RJ, DeChaisemartin C, Dapri G, de Lacy FB, Delrio P, Dzhumabaev K, Fernández-Hevia M, Hahnloser D, Heriot A, Houben B, Horgan AF, Jiménez Toscano M, Katory M, Kneist W, Knol J, Lacy AM, Lezoche E, Mamedli ZZ, Martin-Perez B, Mattacheo A, Maykel JA, Mendes R, Merrie A, Miles A, Muratore A, Nassif GJ, O’Perez R, Panis Y, Pfeffer F, Rasulov AO, Ris F, Rossi G, Rouanet P, São Julião GP, Seitinger G, Sietses C, Simó-Fernández V, Spinelli A, Sylla P, Steele R, Stevenson AR, Tanis P, Tavella O, Tsai A, Tuech JJ, Tuynman JB, Van Nieuwenhove Y, Vorburger S, Weiss H, Wolthuis A, Wynn G, Zorron R.


The TaTME educational workshop in Bristol was funded by an educational Grant from the Olympus Medical (OKMEXP00001988) but had no input on the contents of the workshop or the study.

Compliance with ethical standards


Marta Penna—Marta Penna’s clinical research post is funded by the Oxford Colon Cancer Trust (Occtopus). Nader Francis, Hugh Mackenzie, Fiona Carter, Roel Hompes and International TaTME Educational Collaborative Group have no conflict of interest or financial ties to disclose.

Supplementary material

464_2017_5562_MOESM1_ESM.pdf (44 kb)
Appendix 1: Global Assessment Scoring (GAS) form (PDF 43 kb)
464_2017_5562_MOESM2_ESM.pdf (88 kb)
Appendix 2: International TaTME Training Collaborative Group (PDF 88 kb)


  1. 1.
    Sylla P, Rattner DW, Delgado S, Lacy AM (2010) NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 24(5):1205–1210CrossRefPubMedGoogle Scholar
  2. 2.
    Liyanage C, Ramwell A, Harris GJ, Levy BF, Simson JN (2013) Transanal endoscopic microsurgery: a new technique for completion proctectomy. Colorectal Dis 15:e542–e547PubMedGoogle Scholar
  3. 3.
    Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J, Moran B, Hanna GB, Mortensen NJ, Tekkis PP, TaTME Registry Collaborative (2016) Transanal total mesorectal excision: international registry results of the first 720 cases. Ann Surg. doi: 10.1097/SLA.0000000000001948 (Epub ahead of print) Google Scholar
  4. 4.
    Pucher PH, Mayo D, Dixon AR, Clarke A, Lamparelli MJ (2016) Learning curves and surgical outcomes for proctored adoption of laparoscopic ventral mesh rectopexy: cumulative sum curve analysis. Surg Endosc. doi: 10.1007/s00464-016-5132-2 (Epub ahead of print) Google Scholar
  5. 5.
    Mackenzie H, Cuming T, Miskovic D, Wyles SM, Langsford L, Anderson J, Thomas-Gibson S, Valori R, Hanna GB, Coleman MG, Francis N (2015) Design, delivery, and validation of a trainer curriculum for the national laparoscopic colorectal training program in England. Ann Surg 261(1):149–156. doi: 10.1097/SLA.0000000000000437 CrossRefPubMedGoogle Scholar
  6. 6.
    Cole SJ, Mackenzie H, Ha J, Hanna GB, Miskovic D (2014) Randomized controlled trial on the effect of coaching in simulated laparoscopic training. Surg Endosc 28(3):979–986. doi: 10.1007/s00464-013-3265-0 CrossRefPubMedGoogle Scholar
  7. 7.
    Mackenzie H, Miskovic D, Ni M, Parvaiz A, Acheson AG, Jenkins JT, Griffith J, Coleman MG, Hanna GB (2013) Clinical and educational proficiency gain of supervised laparoscopic colorectal surgical trainees. Surg Endosc 27(8):2704–2711. doi: 10.1007/s00464-013-2806-x CrossRefPubMedGoogle Scholar
  8. 8.
    Francis NK, Weegenaar C, Curtis NJ, Boorman PA, Brook A, Thorpe G, Keogh K, Grainger J, Davies J, Wheeler J, Brown SR, Steele RJ, Dawson P (2017) Barriers and gaps in training and education: Survey of the UK colorectal community. Colorectal DisGoogle Scholar
  9. 9.
    Surveymonkey, TaTME potential learners survey, available at Accessed 8 Mar 2017
  10. 10.
    Penna M, Hompes R, Mackenzie H, Carter F, Francis NK (2016) First international training and assessment consensus workshop on transanal total mesorectal excision (taTME). Tech Coloproctol 20(6):343–352CrossRefPubMedGoogle Scholar
  11. 11.
    Surveymonkey, TaTME experts survey, available at Accessed 8 Mar 2017
  12. 12.
    Hompes R, Arnold S, Warusavitarne J (2014) Towards the safe introduction of transanal total mesorectal excision: the role of a clinical registry. Colorectal Dis 16:498–501CrossRefPubMedGoogle Scholar
  13. 13.
    National Institute for Health and Care Excellence (2015) Transanal total mesorectal excision of the rectum. Interventional procedure guidance. Available at Accessed 8 Mar 2017
  14. 14.
    Fleshman J, Marcello P, Stamos MJ, Wexner SD (2006) Focus Group on Laparoscopic Colectomy Education as endorsed by The American Society of Colon and Rectal Surgeons (ASCRS) and The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Dis Colon Rectum 49(7):945–949CrossRefPubMedGoogle Scholar
  15. 15.
    Penna M, Whiteford M, Hompes R, Sylla P (2016) Developing and assessing a cadaveric training model for transanal total mesorectal excision: initial experience in the UK and USA. Colorectal Dis. doi: 10.1111/codi.13525 (Epub ahead of print) Google Scholar
  16. 16.
    Aigner F, Biebl M, Fürst A, Jöns T, Pratschke J, Kneist W (2017) Training course transanal total mesorectal excision (TaTME): concept and establishment of a training course for safe application. Chirurg. 88(2):147–154. doi: 10.1007/s00104-016-0295-x (article in German) CrossRefPubMedGoogle Scholar
  17. 17.
    McLemore EC, Harnsberger CR, Broderick RC (2015) Transanal total mesorectal excision (taTME) for rectal cancer: a training pathway. Surg Endosc 30(9):4130–4135CrossRefPubMedGoogle Scholar
  18. 18.
    Omnitivity Remote surgical proctoring, advanced technology, available online at Accessed 8 Mar 2017
  19. 19.
    International TaTME Educational Collaborative website (non-profit), available at Accessed 20 Feb 2017
  20. 20.
    iLappSurgery website (basic modules non-profit), available at Accessed 8 Mar 2017
  21. 21.
    Advances In Surgery (AIS) channel website (non-profit), available at Accessed 8 Mar 2017

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Department of Colorectal SurgeryYeovil District Hospital Foundation TrustYeovilUK
  2. 2.Faculty of ScienceUniversity of Bath WessexBathUK
  3. 3.Department of Colorectal Surgery, Churchill HospitalUniversity Hospitals of OxfordOxfordUK
  4. 4.Department of Surgery and CancerImperial College LondonLondonUK
  5. 5.South West Surgical Training NetworkYeovilUK

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