Operating Theater Setup and Two-Team Coordination
Transanal total mesorectal excision (taTME) can be performed by a single-team or a two-team approach. Potential advantages of two-team taTME include faster operative time and fewer conversions to open surgery. Key components of two-team taTME are operating room setup of multiple surgical platforms to allow simultaneous surgery without interference with one another. In two-team taTME, the abdominal team performs the abdominal colon mobilization and upper part of the TME dissection, whereas the transanal team performs the distal rectal transection and mobilization. Coordination of the key steps in taTME surgery is critical to allow for smooth operative flow. One of the critical points during two-team taTME is at the “rendezvous” between the abdominal and transanal dissection where the two dissection planes meet. Here, the abdominal team can retract and expose the rectum to allow the transanal team to carry the dissection forward and vice versa until the rectum is fully dismounted. The rectum may often be removed transanally and anastomosis performed by the transanal team, while the abdominal team performs an ileostomy. In this chapter, the details of operating room setup and coordination between teams for successful taTME surgery in cancer and benign disease are discussed.
KeywordsTwo-team taTME taTME Transanal TME taIPAA Transanal proctectomy
- 3.Penna M et al. Incidence and risk factors for anastomotic failure in 1594 patients treated by transanal total mesorectal excision: results from the international TaTME registry. Ann Surg. 2018. https://doi.org/10.1097/SLA.0000000000002653. [Epub ahead of print].
- 7.Leo CA, Samaranayake S, Perry-Woodford ZL, Vitone L, Faiz O, Hodgkinson JD, Shaikh I, Warusavitarne J. Initial experience of restorative proctocolectomy for ulcerative colitis by transanal total mesorectal rectal excision and single-incision abdominal laparoscopic surgery. Color Dis. 2016;18(12):1162–6.CrossRefGoogle Scholar
- 8.de Buck van Overstraeten A, Mark-Christensen A, Wasmann KA, Bastiaenen VP, Buskens CJ, Wolthuis AM, Vanbrabant K, D’Hoore A, Bemelman WA, Tottrup A, Tanis PJ. Transanal versus transabdominal minimally invasive (completion) proctectomy with ileal pouch-anal anastomosis in ulcerative colitis: a comparative study. Ann Surg. 2017;266(5):878–83.CrossRefGoogle Scholar
- 9.Caycedo-Marulanda A, Jiang HY, Kohtakangas EL. Outcomes of a single surgeon-based transanal-total mesorectal excision (TATME) for rectal cancer. J Gastrointest Cancer. 2017. https://doi.org/10.1007/s12029-017-9989-7. [Epub ahead of print].
- 12.Zaghiyan K, Mendelson B, Eng M, Ovsepyan G, Mirocha J, Fleshner P. Randomized clinical trial comparing laparoscopic vs. ultrasound-guided transversus abdominis plane block in minimally invasive colorectal surgery. Dis Colon Rectum. 2019;62(2):203–10.Google Scholar