Skip to main content


Log in

Midterm functional results of taTME with neuromapping for low rectal cancer

  • Original Article
  • Published:
Techniques in Coloproctology Aims and scope Submit manuscript



Information on functional outcomes after laparoscopic-assisted transanal total mesorectal excision (taTME) is limited. This study analyzed the functional results in patients with low rectal cancer.


Ten consecutive patients (nine males) undergoing electrophysiologically controlled nerve-sparing taTME were investigated prospectively and asked to complete functional questionnaires [the International Prostate Symptom Score (IPSS), International Index of Erectile Function, Female Sexual Function Index, Wexner score, and low anterior resection syndrome (LARS) score]. Bladder function was also assessed according to residual urine volume. Preoperative function was compared to the functional outcome 3 and 6 months, and 9 months if eligible, after stoma closure or surgery in the absence of a diverting stoma.


Prior to therapy, urinary and sexual function was impaired in 40 and 60 % of patients, respectively. None of the patients developed pathological residual urine volumes after at least unilateral functional pelvic nerve-sparing. Median IPSS was lower than preoperative scores (p > 0.05). Two males with incomplete nerve preservation were considered impotent during a median follow-up of 15 months (range 6–20 months). The female was judged to be sexually inactive. The median Wexner score was 1 (range 0–7) prior to any therapy and increased to 7 (range 0–15) at 6 months (p = 0.029), with 40 % of patients categorized as having no LARS and 50 % minor LARS. The median LARS score was 28 (range 9–38) at 3 months and 26 (range 9–32) at 6 months (p = 0.165).


Despite a small sample size and confounding factors, data indicate that taTME has the potential to preserve continence, sufficient bowel function, and urogenital function.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others


  1. Sylla P, Rattner DW, Delgado S, Lacy AM (2010) NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 24:1205–1210

    Article  PubMed  Google Scholar 

  2. Lacy AM, Adelsdorfer C (2011) Totally transrectal endoscopic total mesorectal excision (TME). Colorectal Dis 13(Suppl 7):43–46

    Article  PubMed  Google Scholar 

  3. Rouanet P, Mourregot A, Azar CC et al (2013) Transanal endoscopic proctectomy: an innovative procedure for difficult resection of rectal tumors in men with narrow pelvis. Dis Colon Rectum 56:408–415

    Article  PubMed  Google Scholar 

  4. 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 18:473–480

    Article  PubMed  CAS  Google Scholar 

  5. Fernández-Hevia M, Delgado S, Castells A et al (2015) Transanal total mesorectal excision in rectal cancer: short-term outcomes in comparison with laparoscopic surgery. Ann Surg 261:221–227

    Article  PubMed  Google Scholar 

  6. Tuech JJ, Karoui M, Lelong B et al (2015) A step toward NOTES total mesorectal excision for rectal cancer: endoscopic transanal proctectomy. Ann Surg 261:228–233

    Article  PubMed  Google Scholar 

  7. 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. doi:10.1007/s00464-015-4170-5

    PubMed  Google Scholar 

  8. Veltcamp Helbach M, Deijen CL, Velthuis S, Bonjer HJ, Tuynman JB, Sietses C (2015) Transanal total mesorectal excision for rectal carcinoma: short-term outcomes and experience after 80 cases. Surg Endosc. doi:10.1007/s00464-015-4221-y

    Google Scholar 

  9. Rink AD, Kauff DW, Paschold M, Vestweber KH, Lang H, Kneist W (2015) Hybrid TAMIS total mesorectal excision: a new perspective in treatment of distal rectal cancer—technique and results. Chirurg. doi:10.1007/s00104-015-0043-7

    PubMed  Google Scholar 

  10. Muratore A, Mellano A, Marsanic P, De Simone M (2015) Transanal total mesorectal excision (taTME) for cancer located in the lower rectum: short- and mid-term results. Eur J Surg Oncol 4:478–483

    Article  Google Scholar 

  11. Scheer AS, O’Connor AM, Chan BP et al (2012) The myth of informed consent in rectal cancer surgery: what do patients retain? Dis Colon Rectum 55:970–975

    Article  PubMed  Google Scholar 

  12. Bailey CE, Tran Cao HS, Hu CY et al (2015) Functional deficits and symptoms of long-term survivors of colorectal cancer treated by multimodality therapy differ by age at diagnosis. J Gastrointest Surg 19:180–188

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kneist W, Kauff DW, Lang H (2014) Laparoscopic neuromapping in pelvic surgery: scopes of application. Surg Innov 21:213–220

    Article  PubMed  Google Scholar 

  14. 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. Int J Colorectal Dis 30:71–78

    Article  PubMed  Google Scholar 

  15. Dworak O, Keilholz L, Hoffmann A (1997) Pathological features of rectal cancer after preoperative radiochemotherapy. Int J Colorectal Dis 12:19–23

    Article  PubMed  CAS  Google Scholar 

  16. Barry MJ, Adolfsson J, Batista-Miranda JE et al (1998) Committee 6: measuring the symptoms and health impact of benign prostatic hyperplasia and its treatments. In: Denis L, Griffiths K, Khoury S et al (eds) Proceedings of the fourth international consultation on benign prostatic hyperplasia. Health Publication Ltd, Plymouth, pp 265–321

    Google Scholar 

  17. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A (1997) The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 4:822–830

    Article  Google Scholar 

  18. Cappelleri JC, Rosen RC, Smith MD, Mishra A, Osterloh IH (1999) Diagnostic evaluation of the erectile function domain of the International Index of Erectile Function. Urology 54:346–351

    Article  PubMed  CAS  Google Scholar 

  19. Rosen RC, Brown C, Heiman J et al (2000) The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 26:191–208

    Article  PubMed  CAS  Google Scholar 

  20. Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97

    Article  PubMed  CAS  Google Scholar 

  21. Rothbarth J, Bemelman WA, Meijerink WJ et al (2001) What is the impact of fecal incontinence on quality of life? Dis Colon Rectum 44:67–71

    Article  PubMed  CAS  Google Scholar 

  22. Emmertsen KJ, Laurberg S (2012) Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg 255:922–928

    Article  PubMed  Google Scholar 

  23. Heald RJ (2013) A new solution to some old problems: transanal TME. Tech Coloproctol 17:257–258

    Article  PubMed  CAS  Google Scholar 

  24. Wexner SD, Berho M (2014) Transanal TAMIS total mesorectal excision (TME): a work in progress. Tech Coloproctol 18:423–425

    Article  PubMed  CAS  Google Scholar 

  25. Atallah SB (2015) Transanal total mesorectal excision: full steam ahead. Tech Coloproctol 19:57–61

    Article  PubMed  CAS  Google Scholar 

  26. Hompes R (2015) Robotics and transanal minimal invasive surgery (TAMIS): the “sweet spot” for robotics in colorectal surgery? Tech Coloproctol 19:377–378

    Article  PubMed  CAS  Google Scholar 

  27. Sylla P, Bordeianou LG, Berger D et al (2013) A pilot study of natural orifice transanal endoscopic total mesorectal excision with laparoscopic assistance for rectal cancer. Surg Endosc 27:3396–3405

    Article  PubMed  Google Scholar 

  28. Kneist W, Kauff DW, Rubenwolf P, Thomas C, Hampel C, Lang H (2013) Intraoperative monitoring of bladder and internal anal sphincter innervation: a predictor of erectile function following low anterior rectal resection for rectal cancer? Results of a prospective clinical study. Dig Surg 30:459–465

    Article  PubMed  Google Scholar 

  29. Dumont F, Goere D, Honore C, Elias D (2012) Transanal endoscopic total mesorectal excision combined with single-port laparoscopy. Dis Colon Rectum 55:996–1001

    Article  PubMed  Google Scholar 

  30. Elmore U, Fumagalli Romario U, Vignali A, Sosa MF, Angiolini MR, Rosati R (2015) Laparoscopic anterior resection with transanal total mesorectal excision for rectal cancer: preliminary experience and impact on postoperative bowel function. J Laparoendosc Adv Surg Tech 2:364–369

    Article  Google Scholar 

  31. Borreca D, Bona A, Bellomo MP, Borasi A, De Paolis P (2015) The new approach to rectal cancer: ‘down-to-up’ double endolaparoscopic pelvic access: preliminary evaluation of outcomes. Updates Surg 67:293–299

    Article  PubMed  Google Scholar 

  32. Denost Q, Adam JP, Pontallier A, Celerier B, Laurent C, Rullier E (2015) Laparoscopic total mesorectal excision with coloanal anastomosis for rectal cancer. Ann Surg 261:138–143

    Article  PubMed  Google Scholar 

  33. Chen TY, Emmertsen KJ, Laurberg S (2015) What are the best questionnaires to capture anorectal function after surgery in rectal cancer? Curr Colorectal Cancer Rep 11:37–43

    Article  PubMed  PubMed Central  Google Scholar 

Download references


The authors would like to thank Dr. Ursula Gönner for fruitful discussions and psycho-oncological support of our patients.

Author information

Authors and Affiliations


Corresponding author

Correspondence to W. Kneist.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kneist, W., Wachter, N., Paschold, M. et al. Midterm functional results of taTME with neuromapping for low rectal cancer. Tech Coloproctol 20, 41–49 (2016).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: