Critical Anatomical Landmarks in Transanal Total Mesorectal Excision (taTME)

  • Stephen W. Bell


The introduction of transanal endoscopic techniques to the surgical management of rectal neoplasia has led to an improvement in surgical technique but also the development of different potential complications. The cornerstone to all surgical dissection is a clear understanding of and identification of anatomical landmarks, as well as the correct and incorrect anatomical planes. The anatomy of the extraperitoneal rectum is familiar to most practicing colorectal surgeons; however this familiarity is predominantly from an abdominal approach, entering the pelvis from above. The anatomy when viewed from below (transanally) is the same; however the view is quite different and thus necessitates a relearning of the anatomy as it is seen from this direction. This chapter will focus on the applied surgical anatomy required for surgeon mastery of transanal total mesorectal excision (taTME). It will not detail all anatomic structures of the anorectum, pelvis, and pelvic floor as this is assumed knowledge.


taTME Anatomy Transanal TME Pelvic anatomy Surgical anatomy 

Suggested Reading

  1. Atallah S, Albert M, Monson JR. Critical concepts and important anatomic landmarks encountered during transanal total mesorectal excision (taTME): toward the mastery of a new operation for rectal cancer surgery. Tech Coloproctol. 2016;20(7):483–94. Epub 2016 May 17.CrossRefPubMedGoogle Scholar
  2. Atallah S, Mabardy A, Volpato AP, Chin T, Sneider J, Monson JRT. Surgery beyond the visible light spectrum: theoretical and applied methods for localization of the male urethra during transanal total mesorectal excision. Tech Coloproctol. 2017;21(6):413–24. Epub 2017 Jun 6.CrossRefPubMedGoogle Scholar
  3. Bernardi MP, Bloemendaal AL, Albert M, Whiteford M, Stevenson AR, Hompes R. Transanal total mesorectal excision: dissection tips using ‘O’s and ‘triangles’. Tech Coloproctol. 2016;20(11):775–8. Epub 2016 Oct 1.CrossRefGoogle Scholar
  4. Knol J, Chadi SA. Transanal total mesorectal excision: technical aspects of approaching the mesorectal plane from below. Minim Invasive Ther Allied Technol. 2016;25(5):257–70. Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Stephen W. Bell
    • 1
    • 2
  1. 1.Cabrini Monash University Department of SurgeryMalvernAustralia
  2. 2.Alfred HospitalMelbourneAustralia

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