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Techniques in Coloproctology

, Volume 19, Issue 2, pp 69–82 | Cite as

Transanal total mesorectal excision: a systematic review of the experimental and clinical evidence

  • S. E. Araujo
  • B. Crawshaw
  • C. R. Mendes
  • C. P. Delaney
Review

Abstract

Achieving a clear distal or circumferential resection margins with laparoscopic total mesorectal excision (TME) may be laborious, especially in obese males and when operating on advanced distal rectal tumors with a poor response to neoadjuvant treatment. Transanal (TaTME) is a new natural orifice translumenal endoscopic surgery modality in which the rectum is mobilized transanally using endoscopic techniques with or without laparoscopic assistance. We conducted a comprehensive systematic review of publications on this new technique in PubMed and Embase databases from January, 2008, to July, 2014. Experimental and clinical studies written in English were included. Experimental research with TaTME was done on pigs with and without survival models and on human cadavers. In these studies, laparoscopic or transgastric assistance was frequently used resulting in an easier upper rectal dissection and in a longer rectal specimen. To date, 150 patients in 16 clinical studies have undergone TaTME. In all but 15 cases, transabdominal assistance was used. A rigid transanal endoscopic operations/transanal endoscopic microsurgery (TEO/TEM) platform was used in 37 patients. Rectal adenocarcinoma was the indication in all except for nine cases of benign diseases. Operative times ranged from 90 to 460 min. TME quality was deemed intact, satisfactory, or complete. Involvement in circumferential resection margins was detected in 16 (11.8 %) patients. The mean lymph node harvest was equal or greater than 12 in all studies. Regarding morbidity, pneumoretroperitoneum, damage to the urethra, and air embolism were reported intraoperatively. Mean hospital stay varied from 4 to 14 days. Postoperative complications occurred in 34 (22.7 %) patients. TaTME with TEM is feasible in selected cases. Oncologic safety parameters seem to be adequate although the evidence relies on small retrospective series conducted by highly trained surgeons. Further studies are expected.

Keywords

Transanal TME TAMIS Transanal proctectomy NOTES TME TEM 

Notes

Conflict of interest

None.

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Copyright information

© Springer-Verlag Italia Srl 2014

Authors and Affiliations

  • S. E. Araujo
    • 1
  • B. Crawshaw
    • 2
  • C. R. Mendes
    • 3
  • C. P. Delaney
    • 4
  1. 1.Department of GastroenterologyUniversity of Sao Paulo Medical SchoolSão PauloBrazil
  2. 2.Department of SurgeryUniversity Hospitals Case Medical CenterClevelandUSA
  3. 3.Colorectal Surgery UnitHospital Santa IzabelSalvadorBrazil
  4. 4.Colorectal Surgery UnitUniversity Hospitals Case Medical CenterClevelandUSA

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