Zen and the Art of the Purse-String
Just like a storybook, every surgical procedure has a beginning, middle and an end. Each part of the operation requires careful attention, but perhaps the most important part of transanal total mesorectal excision (taTME) surgery is the beginning – the purse-string. The creation of a sound and perfect purse-string sets the foundation for successful surgery to follow. This chapter is largely based on personal experience with observations made by myself and colleagues conducting workshops from around the globe. This is often found to be a time-intensive exercise for novice surgeons, who typically require multiple attempts to achieve the goal of a water- and airtight purse-string. The many tips described here will provide the surgeon with the necessary tools to secure the perfect purse-string.