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Clin Colon Rectal Surg 2020; 33(03): 113-127
DOI: 10.1055/s-0039-3402773
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Evolution of Transanal Total Mesorectal Excision

Heather Carmichael
1   Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
,
Patricia Sylla
2   Icahn School Medicine at Mount Sinai, New York, New York
3   Division of Colon and Rectal Surgery, Department of Surgery, Mount Sinai Hospital, New York, New York
› Author Affiliations
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Publication History

Publication Date:
28 April 2020 (online)

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Abstract

Minimally invasive techniques continue to transform the field of colorectal surgery. Because traditional surgical approaches for rectal cancer are associated with significant mortality and morbidity, developing less invasive approaches to this disease is paramount. Natural orifice transluminal endoscopic surgery (NOTES), commonly known as “no incision surgery,” represents the ultimate minimally invasive approach to disease. Although transgastric and transvaginal approaches for NOTES surgery were the initially explored, a transrectal approach for colorectal disease is intuitive given that it makes use of the resected organ for transluminal access. Furthermore, the transanal approach allows for improved, precise visualization of the presacral mesorectal plane compared with an abdominal viewpoint, particularly in the narrow, male pelvis. Finally, experience with existing transanal platforms that have been used for decades for local excision of rectal disease made the development of a transanal approach to total mesorectal excision (TME) feasible. Here, we will review the evolution of minimally invasive and transanal surgical techniques that allowed for the development of transanal TME and its introduction into clinical practice.

Keywords

transanal total mesorectal excision - rectal cancer - natural orifice transluminal endoscopic surgery
 

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