Transanal total mesorectal excision: dissection tips using ‘O’s and ‘triangles’
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Transanal total mesorectal excision (taTME) requires specific technical expertise, as it is often difficult to ascertain the correct dissection plane. Consequently, one can easily enter an incorrect plane, potentially resulting in bleeding (sidewall or presacral vessels), autonomic nerve injury and urethral injury. We aim to demonstrate specific visual features, which may be encountered during surgery and can guide the surgeon to perform the dissection in the correct plane.
Specific features of dissection in the correct and incorrect planes are demonstrated in the accompanying video.
The ‘triangles’ created using appropriate traction can aid in performing a precise dissection in the correct plane. Recognition of features described as ‘O’s can alert surgeons that they are entering a new fascial plane and can avoid incursion into an incorrect plane.
Understanding and recognizing the described features which can be encountered in taTME surgery, a safe and accurate TME dissection can be facilitated.
KeywordsTotal mesorectal excision Transanal TME ‘O’sand ‘triangles’
Compliance with ethical standards
Conflict of interest
Matthew Albert is a paid consultant for Applied Medical and ConMed. Andrew Stevenson receives an Honorarium from Applied Medical for workshops and proctoring taTME. Roel Hompes is a regular faculty member of TAMIS courses for Applied Medical. The remaining authors have no conflicts of interest to declare.
All procedures performed were in accordance with the ethical standards of the institutions and with the 1964 Helsinki declaration and its later amendments.
Informed consent was obtained from all individual participants included in the study for the purposes of video footage.
Supplementary material 1 (MP4 474155 kb)
- 4.(NICE) NIfHaCE (2015), Transanal total mesorectal excision of the rectum, inteventional procedure guidance. http://www.nice.org.uk/guidance/ipg514/resources/transanal-total-mesorectal-excision-of-the-rectum-1899871745394373. Accessed 22 Feb 2016