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Techniques in Coloproctology

, Volume 20, Issue 7, pp 483–494 | Cite as

Critical concepts and important anatomic landmarks encountered during transanal total mesorectal excision (taTME): toward the mastery of a new operation for rectal cancer surgery

  • S. Atallah
  • M. Albert
  • J. R. T. Monson
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Abstract

Over the past 3 years, colorectal surgeons have begun to adapt the technique of transanal total mesorectal excision. As international experience has been quickly forged, an improved recognition of the pitfalls and the practical details of this disruptive technique have been realized. The purpose of this technical note was to express the various nuances of transanal total mesorectal excision as learned during the course of its clinical application and international teaching, so as to rapidly communicate and share important insights with other surgeons who are in the early adoption phase of this approach. The technical points specific to transanal total mesorectal excision are addressed herein. When correctly applied, these will likely improve the quality of surgery and decrease morbidity attributable to inexperience with the transanal approach to total mesorectal excision.

Keywords

Transanal TME TAMIS Rectal cancer Transanal total mesorectal excision (taTME) 

Notes

Compliance with ethical standards

Conflict of interest

The authors received no funding for this study, and the research was not supported by any grants or other funding. Dr. S. Atallah and M. Albert are paid consultants for ConMed, Inc. and Applied Medical, Inc. Dr. J. R. T. Monson is an advisor for Twistle.com and received teaching honoraria from Applied Medical, Inc., and Covidien.

Ethical approval

This study involved no human participants. This research was performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was not applicable in this study.

References

  1. 1.
    Cahill RA, Hompes R (2015) Transanal total mesorectal excision. Br J Surg 102:1591–1593CrossRefPubMedGoogle Scholar
  2. 2.
    Atallah S (2015) Transanal total mesorectal excision: full steam ahead. Tech Coloproctol 19:57–61CrossRefPubMedGoogle Scholar
  3. 3.
    Wexner SD, Berho M (2015) Transanal total mesorectal excision of rectal carcinoma: evidence to learn and adopt the technique. Ann Surg 261:234–236CrossRefPubMedGoogle Scholar
  4. 4.
    Atallah S (2014) Transanal minimally invasive surgery for total mesorectal excision. Minim Invasive Ther Allied Technol 23:10–16CrossRefPubMedGoogle Scholar
  5. 5.
    D’Hoore A, Wolthuis AM, Sands DR, Wexner S (2016) Transanal total mesorectal excision: the work is progressing well. Dis Colon Rectum 59:247–250CrossRefPubMedGoogle Scholar
  6. 6.
    Heald RJ (2013) A new solution to some old problems: transanal TME. Tech Coloproctol 17:257–258CrossRefPubMedGoogle Scholar
  7. 7.
    McLemore EC, Harnsberger CR, Broderick RC et al (2015) Transanal total mesorectal excision (taTME) for rectal cancer: a training pathway. Surg Endosc. doi: 10.1007/s00464-015-4680-1
  8. 8.
    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
  9. 9.
    Atallah S, Albert M, Larach S (2010) Transanal minimally invasive surgery: a giant leap forward. Surg Endosc 24:2200–2205CrossRefPubMedGoogle Scholar
  10. 10.
    Atallah S, Albert M, DeBeche-Adams T, Nassif G, Polavarapu H, Larach S (2013) Transanal minimally invasive surgery for total mesorectal excision (TAMIS-TME): a stepwise description of the surgical technique with video demonstration. Tech Coloproctol 17:321–325CrossRefPubMedGoogle Scholar
  11. 11.
    Atallah S, Martin-Perez B, Albert M et al (2014) Transanal minimally invasive surgery for total mesorectal excision (TAMIS-TME): results and experience with the first 20 patients undergoing curative-intent rectal cancer surgery at a single institution. Tech Coloproctol 18:473–480CrossRefPubMedGoogle Scholar
  12. 12.
    Burke JP, Martin-Perez B, Khan A et al (2016) Transanal total mesorectal excision for rectal cancer: early outcomes in 50 consecutive patients. Colorectal Dis. doi: 10.1111/codi.13263 Google Scholar
  13. 13.
    Turnbull RB (1975) The no-touch isolation technique of resection. JAMA 11:1181–1182CrossRefGoogle Scholar
  14. 14.
    Kanso F, Maggiori L, Debove C, Chau A, Ferron M, Panis Y (2015) Perineal or abdominal approach first during intersphincteric resection for low rectal cancer: which is the best strategy? Dis Colon Rectum 58:637–644CrossRefPubMedGoogle Scholar
  15. 15.
    García-Olmo D, Ontañón J, García-Olmo DC, Vallejo M, Cifuentes J (1999) Experimental evidence does not support use of the “no-touch” isolation technique in colorectal cancer. Dis Colon Rectum 42:1449–1456CrossRefPubMedGoogle Scholar
  16. 16.
    Atallah S (2015) Have we forgotten the most important tenet of oncologic surgery? Dis Colon Rectum 58:e457–e458CrossRefPubMedGoogle Scholar
  17. 17.
    Burghardt J, Buess G (2005) Transanal endoscopic microsurgery (TEM): a new technique and development during a time period of 20 years. Surg Technol Int 14:131–137PubMedGoogle Scholar
  18. 18.
    Keller DS, Haas EM (2015) Transanal minimally invasive surgery: state of the art. J Gastrointest Surg 20:463–469CrossRefPubMedGoogle Scholar
  19. 19.
    deBeche-Adams T, Nassif G (2015) Transanal minimally invasive surgery. Clin Colon Rectal Surg 28:176–180CrossRefPubMedGoogle Scholar
  20. 20.
    Martin-Perez B, Andrade-Ribeiro GD, Hunter L, Atallah S (2014) A systematic review of transanal minimally invasive surgery (TAMIS) from 2010 to 2013. Tech Coloproctol 18:775–788CrossRefPubMedGoogle Scholar
  21. 21.
    Araujo SE, Crawshaw B, Mendes CR, Delaney CP (2015) Transanal total mesorectal excision: a systematic review of the experimental and clinical evidence. Tech Coloproctol 19:69–82CrossRefPubMedGoogle Scholar
  22. 22.
    Bislenghi G, Wolthuis AM, de Buck van Overstraeten A, D’Hoore A (2015) AirSeal system insufflator to maintain a stable pneumorectum during TAMIS. Tech Coloproctol 19:43–45CrossRefPubMedGoogle Scholar
  23. 23.
    Nicholson G, Knol J, Houben B, Cunningham C, Ashraf S, Hompes R (2015) Optimal dissection for transanal total mesorectal excision using modified CO2 insufflation and smoke extraction. Colorectal Dis 17:O265–O267CrossRefPubMedGoogle Scholar
  24. 24.
    Serra-Aracil X, Mora-López L, Casalots A, Pericay C, Guerrero R, Navarro-Soto S (2015) Hybrid NOTES: TEO for transanal total mesorectal excision: intracorporeal resection and anastomosis. Surg Endosc 30:346–354CrossRefPubMedGoogle Scholar
  25. 25.
    Ghafoori M, Shakiba M, Seifmanesh H, Hoseini K (2012) Decrease in infection rate following use of povidone-iodine during transrectal ultrasound guided biopsy of the prostate: a double blind randomized clinical trial. Iran J Radiol 9:67–70CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Hwang EC, Jung S, Seo YH et al (2015) Risk factors for and prophylactic effect of povidone-iodine rectal cleansing on infectious complications after prostate biopsy: a retrospective cohort study. Int Urol Nephrol 47:595–6012CrossRefPubMedGoogle Scholar
  27. 27.
    Abughosh Z, Margolick J, Goldenberg SL et al (2013) A prospective randomized trial of povidone-iodine prophylactic cleansing of the rectum before transrectal ultrasound guided prostate biopsy. J Urol 189:1326–1331CrossRefPubMedGoogle Scholar
  28. 28.
    Scammell BE, Phillips RP, Brown R, Burdon DW, Keighley MRB (1985) Influence of rectal washout on bacterial counts in the rectal stump. Br J Surg 72:548–550CrossRefPubMedGoogle Scholar
  29. 29.
    Banich FE, Mendak SJ Jr (1989) Intraoperative colonic irrigation with povidone iodine: an effective method of wound sepsis prevention. Dis Colon Rectum 32:219–222CrossRefPubMedGoogle Scholar
  30. 30.
    Velthuis S, Veltcamp Helbach M, Tuynman JB, Le TN, Bonjer HJ, Sietses C (2015) Intra-abdominal bacterial contamination in TAMIS total mesorectal excision for rectal carcinoma: a prospective study. Surg Endosc 29:3319–3323CrossRefPubMedGoogle Scholar
  31. 31.
    Rygick AN, Fain SN, Pestovskaja GN (1969) Viability of cancer cells penetrating tissues during operation for cancer of the rectum. Dis Colon Rectum 12:351–356CrossRefPubMedGoogle Scholar
  32. 32.
    Skipper D, Cooper AJ, Marson JE, Taylor I (1987) Exfoliated cells and in vitro growth in colorectal cancer. Br J Surg 74:1049–1052CrossRefPubMedGoogle Scholar
  33. 33.
    Umpleby HC, Fermor B, Symes MO, Williamson RC (1984) Viability of exfoliated colorectal carcinoma cells. Br J Surg 71:659–663CrossRefPubMedGoogle Scholar
  34. 34.
    Tsunoda A, Shibusawa M, Kamiyama G, Takata M, Yokoyama N, Kusano M (1996) Viability of free malignant cells in specimens removed because of colorectal carcinoma. Jpn J Gastroenterol Surg 29:1022–1027CrossRefGoogle Scholar
  35. 35.
    Yu S-K, Cohn I (1968) Tumor implantation on colon mucosa. Arch Surg 96:956–958CrossRefPubMedGoogle Scholar
  36. 36.
    Leather AJM, Yiu CY, Baker LA et al (1991) Passage of shed intraluminal colorectal cancer cells across a sealed anastomosis. Br J Surg 78:756Google Scholar
  37. 37.
    Kluger Y, Galili Y, Yossiphov J, Shnaper A, Goldman G, Rabau M (1998) Model of implantation of tumor cells simulating recurrence in colonic anastomosis in mice. Dis Colon Rectum 41:1506–1510CrossRefPubMedGoogle Scholar
  38. 38.
    Keynes WM (1961) Implantation from the bowel lumen in cancer of the large intestine. Ann Surg 153:357–364CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Long TL, Edwards RH (1989) Implantation Metastasis as a cause of local recurrence of colorectal carcinoma. Am J Surg 157:194–200CrossRefPubMedGoogle Scholar
  40. 40.
    McGrew EA, Laws JF, Cole WH (1954) Free malignant cells in relation to recurrence of carcinoma of the colon. JAMA 154:1251–1254CrossRefGoogle Scholar
  41. 41.
    Vink M (1954) Local recurrence of cancer in the large bowel: the role of implantation metastases and bowel disinfection. Br J Surg 41:431–433CrossRefPubMedGoogle Scholar
  42. 42.
    Jenner DC, de Boer WB, Clarke G, Levitt MD (1998) Rectal washout eliminates exfoliated malignant cells. Dis Colon Rectum 41:1432–1434CrossRefPubMedGoogle Scholar
  43. 43.
    Sayfan J, Averbuch F, Koltun L, Benyamin N (2000) Effect of rectal stump washout on the presence of free malignant cells in the rectum during anterior resection for rectal cancer. Dis Colon Rectum 43:1710–1712CrossRefPubMedGoogle Scholar
  44. 44.
    Maeda K, Maruta M, Hanai T, Sato H, Horibe Y (2004) Irrigation volume determines the efficacy of “rectal washout”. Dis Colon Rectum 47:1706–1710CrossRefPubMedGoogle Scholar
  45. 45.
    Edwards DP, Sexton R, Heald RJ, Moran BJ (2007) Long-term results show triple stapling facilitates safe low colorectal and coloanal anastomosis and is associated with low rates of local recurrence after anterior resection for rectal cancer. Tech Coloproctol 11:17–21CrossRefPubMedGoogle Scholar
  46. 46.
    Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK (1998) Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 133:894–899CrossRefPubMedGoogle Scholar
  47. 47.
    Atallah S, DuBose A (2015) A mechanism for constructing a durable purse-string during transanal total mesorectal excision. Tech Coloproctol 19:751–752CrossRefPubMedGoogle Scholar
  48. 48.
    Walsh PC (2005) Anatomical studies of the neurovascular bundle and cavernosal nerves. J Urol 174:566CrossRefPubMedGoogle Scholar
  49. 49.
    Atallah S, Albert M (2016) The neurovascular bundle of Walsh and other anatomic considerations crucial in preventing urethral injury in males undergoing transanal total mesorectal excision. Tech Coloproct. doi: 10.1007/s10151-016-1468-9 Google Scholar
  50. 50.
    Atallah S, Martin-Perez B, Drake J, Stotland P, Ashamalla S, Albert M (2015) The use of a lighted stent as a method for identifying the urethra in male patients undergoing transanal total mesorectal excision: a video demonstration. Tech Coloproctol 19:375CrossRefPubMedGoogle Scholar
  51. 51.
    Atallah S, Nassif G, Larach S (2015) Stereotactic navigation for TAMIS-TME: opening the gateway to frameless, image-guided abdominal and pelvic surgery. Surg Endosc 29:207–211CrossRefPubMedGoogle Scholar
  52. 52.
    Atallah S, Martin-Perez B, Larach S (2015) Image-guided real-time navigation for transanal total mesorectal excision: a pilot study. Tech Coloproctol 19:679–684CrossRefPubMedGoogle Scholar
  53. 53.
    Franchini Melani AG, Diana M, Marescaux J (2016) The quest for precision in transanal total mesorectal excision. Tech Coloproctol 20:11–18CrossRefPubMedGoogle Scholar
  54. 54.
    Buchs NC, Hompes R (2015) Stereotactic navigation and augmented reality for transanal total mesorectal excision? Colorectal Dis 17:825–827CrossRefPubMedGoogle Scholar
  55. 55.
    Liba O, SoRelle ED, Sen D, de la Zerda A (2016) Contrast-enhanced optical coherence tomography with picomolar sensitivity for functional in vivo imaging. Sci Rep 18:23337CrossRefGoogle Scholar
  56. 56.
    Kneist W, Rink AD, Kauff DW, Konerding MA, Lang H (2015) Topography of the extrinsic internal anal sphincter nerve supply during laparoscopic-assisted TAMIS TME: five key zones of risk from the surgeons’ view. Tech Coloproctol 19:751–752CrossRefGoogle Scholar
  57. 57.
    Penna M, Knol JJ, Tuynman JB, Tekkis PP, Mortensen NJ, Hompes R (2016) Four anastomotic techniques following transanal total mesorectal excision (TaTME). Tech Coloproctol 20:185–191CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Bracey E, Knol J, Buchs N et al (2015) Technique for a stapled anastomosis following transanal total mesorectal excision for rectal cancer. Colorectal Dis 17:O208–O212CrossRefPubMedGoogle Scholar
  59. 59.
    Kearns JE, Nesselrod JP (1955) Two-team combined abdominoperineal operation. Q Bull Northwest Univ Med Sch 29:154PubMedPubMedCentralGoogle Scholar
  60. 60.
    Atallah S, Drake J, Martin-Perez B, Kang C, Larach S (2015) Robotic transanal total mesorectal excision with intersphincteric dissection for extreme distal rectal cancer: a video demonstration. Tech Coloproctol 19:435CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia Srl 2016

Authors and Affiliations

  1. 1.Florida HospitalWinter ParkUSA

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