Abstract
A dynamic evolution is occurring in transanal surgery. Transanal techniques began
with intraluminal surgical removal of rectal masses and have progressed to transanal
total mesorectal excision (taTME) for rectal cancer. TaTME was first performed in
2009 by Sylla, Rattner, Delgado, and Lacy. This article documents the training pathway
followed by pioneers in the taTME technique as well as consensus reports outlining
the process of learning the taTME technique. A literature search was performed for
taTME training, learning, and technique. Key elements in learning the taTME technique
include appropriate indications, cadaver training, and outcomes reporting such as
participating in a taTME registry. Consensus reports also agree on the following facets
associated with improved outcomes: (1) appropriate case selection of mid and low rectal
cancers, (2) prerequisite completion of an accredited training program in laparoscopic
colorectal surgery and prior experience in transanal endoscopic surgery, (3) a two-team
taTME approach from above and below is ideal, and (4) higher rectal cancer volume
surgical practice. The unifying international recommendation for surgeons interested
in learning the taTME technique conveys the following message: taTME is an advanced
and complex technique that requires dedicated training and experience in TME surgery.
Keywords
taTME - transanal - total mesorectal excision - rectal cancer - training
