Clin Colon Rectal Surg 2021; 34(03): 163-171
DOI: 10.1055/s-0040-1718682
Review Article

Education and Training in Transanal Endoscopic Surgery and Transanal Total Mesorectal Excision

Deborah S. Keller
1   Division of Colorectal Surgery, Department of Surgery, Columbia University Medical Center, New York, New York
F. Borja de Lacy
2   Department of Gastrointestinal Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain
Roel Hompes
3   Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherland
› Author Affiliations


There is a paradigm shift in surgical training, and new tool and technology are being used to facilitate mastery of the content and technical skills. The transanal procedures for rectal cancer—transanal endoscopic surgery (TES) and transanal total mesorectal excision (TaTME)—have a distinct learning curve for competence in the procedures, and require special training for familiarity with the “bottom-up” anatomy, procedural risks, and managing complex cases. These procedures have been models for structured education and training, using multimodal tools, to ensure safe implementation of TES and TaTME into clinical practice. The goal of this work was to review the current state of surgical education, the introduction and learning curve of the TES and TaTME procedures, and the established and future models for education of the transanal procedures for rectal cancer.

Publication History

Article published online:
31 March 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

  • References

  • 1 Kneebone R, ApSimon D. Surgical skills training: simulation and multimedia combined. Med Educ 2001; 35 (09) 909-915
  • 2 Miller G, Bamboat ZM, Allen F. et al. Impact of mandatory resident work hour limitations on medical students' interest in surgery. J Am Coll Surg 2004; 199 (04) 615-619
  • 3 Pickersgill T. The European working time directive for doctors in training. BMJ 2001; 323 (7324): 1266
  • 4 Reznick RK, MacRae H. Teaching surgical skills--changes in the wind. N Engl J Med 2006; 355 (25) 2664-2669
  • 5 Webster PC. Richard Reznick: leading innovator of surgical education. Lancet 2011; 378 (9785): 21
  • 6 Knol J, Keller DS. Cognitive skills training in digital era: a paradigm shift in surgical education using the TaTME model. Surgeon 2019; 17 (01) 28-32
  • 7 Siegel RL, Miller KD, Fedewa SA. et al. Colorectal cancer statistics, 2017. CA Cancer J Clin 2017; 67 (03) 177-193
  • 8 Heald RJ. The 'Holy Plane' of rectal surgery. J R Soc Med 1988; 81 (09) 503-508
  • 9 Salerno G, Sinnatamby C, Branagan G, Daniels IR, Heald RJ, Moran BJ. Defining the rectum: surgically, radiologically and anatomically. Colorectal Dis 2006; 8 (Suppl. 03) 5-9
  • 10 Heald RJ, Santiago I, Pares O, Carvalho C, Figueiredo N. The perfect total mesorectal excision obviates the need for anything else in the management of most rectal cancers. Clin Colon Rectal Surg 2017; 30 (05) 324-332
  • 11 Wibe A, Møller B, Norstein J. et al; Norwegian Rectal Cancer Group. A national strategic change in treatment policy for rectal cancer--implementation of total mesorectal excision as routine treatment in Norway. A national audit. Dis Colon Rectum 2002; 45 (07) 857-866
  • 12 Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK. Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978-1997. Arch Surg 1998; 133 (08) 894-899
  • 13 Quirke P, Steele R, Monson J. et al; MRC CR07/NCIC-CTG CO16 Trial Investigators, NCRI Colorectal Cancer Study Group. Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet 2009; 373 (9666): 821-828
  • 14 Lacy AM, García-Valdecasas JC, Delgado S. et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 2002; 359 (9325): 2224-2229
  • 15 Schwenk W, Haase O, Neudecker J, Müller JM. Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev 2005; 20 (03) CD003145
  • 16 Veldkamp R, Kuhry E, Hop WC. et al; COlon cancer Laparoscopic or Open Resection Study Group (COLOR). Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 2005; 6 (07) 477-484
  • 17 Jeong SY, Park JW, Nam BH. et al. Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol 2014; 15 (07) 767-774
  • 18 Bonjer HJ, Deijen CL, Abis GA. et al; COLOR II Study Group. A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 2015; 372 (14) 1324-1332
  • 19 Jayne DG, Guillou PJ, Thorpe H. et al; UK MRC CLASICC Trial Group. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 2007; 25 (21) 3061-3068
  • 20 Aly OE, Quayyum Z. Has laparoscopic colorectal surgery become more cost-effective over time?. Int J Colorectal Dis 2012; 27 (07) 855-860
  • 21 Keller DS, Champagne BJ, Reynolds Jr HLJ, Stein SL, Delaney CP. Cost-effectiveness of laparoscopy in rectal cancer. Dis Colon Rectum 2014; 57 (05) 564-569
  • 22 Dowson HM, Huang A, Soon Y, Gage H, Lovell DP, Rockall TA. Systematic review of the costs of laparoscopic colorectal surgery. Dis Colon Rectum 2007; 50 (06) 908-919
  • 23 McLemore EC, Harnsberger CR, Broderick RC. et al. Transanal total mesorectal excision (taTME) for rectal cancer: a training pathway. Surg Endosc 2016; 30 (09) 4130-4135
  • 24 Carmichael JC, Masoomi H, Mills S, Stamos MJ, Nguyen NT. Utilization of laparoscopy in colorectal surgery for cancer at academic medical centers: does site of surgery affect rate of laparoscopy?. Am Surg 2011; 77 (10) 1300-1304
  • 25 Keller DS, Qiu J, Senagore AJ. Predicting opportunities to increase utilization of laparoscopy for rectal cancer. Surg Endosc 2018; 32 (03) 1556-1563
  • 26 Musselman RP, Gomes T, Chan BP. et al. Changing trends in rectal cancer surgery in Ontario: 2002-2009. Colorectal Dis 2012; 14 (12) 1467-1472
  • 27 Fleshman J, Branda ME, Sargent DJ. et al. Disease-free survival and local recurrence for laparoscopic resection compared with open resection of stage II to III rectal cancer: follow-up results of the ACOSOG Z6051 randomized controlled trial. Ann Surg 2019; 269 (04) 589-595
  • 28 Stevenson ARL, Solomon MJ, Brown CSB. et al. Disease-free survival and local recurrence after laparoscopic-assisted resection or open resection for rectal cancer: the Australasian Laparoscopic Cancer of the Rectum Randomized Clinical Trial. Ann Surg 2019; 269 (04) 596-602
  • 29 Jayne D, Pigazzi A, Marshall H. et al. Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial. JAMA 2017; 318 (16) 1569-1580
  • 30 Bastawrous A, Baer C, Rashidi L, Neighorn C. Higher robotic colorectal surgery volume improves outcomes. Am J Surg 2018; 215 (05) 874-878
  • 31 Kim CW, Kim CH, Baik SH. Outcomes of robotic-assisted colorectal surgery compared with laparoscopic and open surgery: a systematic review. J Gastrointest Surg 2014; 18 (04) 816-830
  • 32 Keller DS, Hashemi L, Lu M, Delaney CP. Short-term outcomes for robotic colorectal surgery by provider volume. J Am Coll Surg 2013; 217 (06) 1063-9.e1
  • 33 Keller DS, Senagore AJ, Lawrence JK, Champagne BJ, Delaney CP. Comparative effectiveness of laparoscopic versus robot-assisted colorectal resection. Surg Endosc 2014; 28 (01) 212-221
  • 34 Bentrem DJ, Okabe S, Wong WD. et al. T1 adenocarcinoma of the rectum: transanal excision or radical surgery?. Ann Surg 2005; 242 (04) 472-477 , discussion 477–479
  • 35 Endreseth BH, Myrvold HE, Romundstad P, Hestvik UE, Bjerkeset T, Wibe A. Norwegian Rectal Cancer Group. Transanal excision vs. major surgery for T1 rectal cancer. Dis Colon Rectum 2005; 48 (07) 1380-1388
  • 36 Madbouly KM, Remzi FH, Erkek BA. et al. Recurrence after transanal excision of T1 rectal cancer: should we be concerned?. Dis Colon Rectum 2005; 48 (04) 711-719 , discussion 719–721
  • 37 Heafner TA, Glasgow SC. A critical review of the role of local excision in the treatment of early (T1 and T2) rectal tumors. J Gastrointest Oncol 2014; 5 (05) 345-352
  • 38 Keller DS, Reali C, Spinelli A. et al. Patient-reported functional and quality-of-life outcomes after transanal total mesorectal excision. Br J Surg 2019; 106 (04) 364-366
  • 39 Kulu Y, Müller-Stich BP, Bruckner T. et al. Radical surgery with total mesorectal excision in patients with T1 rectal cancer. Ann Surg Oncol 2015; 22 (06) 2051-2058
  • 40 Chakravarti A, Compton CC, Shellito PC. et al. Long-term follow-up of patients with rectal cancer managed by local excision with and without adjuvant irradiation. Ann Surg 1999; 230 (01) 49-54
  • 41 Stijns RCH, de Graaf EJR, Punt CJA. et al. Long-term oncological and functional outcomes of chemoradiotherapy followed by organ-sparing transanal endoscopic microsurgery for distal rectal cancer: the CARTS Study. JAMA Surg 2019; 154 (01) 47-54
  • 42 Bach SP, Hill J, Monson JR. et al; Association of Coloproctology of Great Britain and Ireland Transanal Endoscopic Microsurgery (TEM) Collaboration. A predictive model for local recurrence after transanal endoscopic microsurgery for rectal cancer. Br J Surg 2009; 96 (03) 280-290
  • 43 Nash GM, Weiser MR, Guillem JG. et al. Long-term survival after transanal excision of T1 rectal cancer. Dis Colon Rectum 2009; 52 (04) 577-582
  • 44 Clancy C, Burke JP, Albert MR, O'Connell PR, Winter DC. Transanal endoscopic microsurgery versus standard transanal excision for the removal of rectal neoplasms: a systematic review and meta-analysis. Dis Colon Rectum 2015; 58 (02) 254-261
  • 45 Moore JS, Cataldo PA, Osler T, Hyman NH. Transanal endoscopic microsurgery is more effective than traditional transanal excision for resection of rectal masses. Dis Colon Rectum 2008; 51 (07) 1026-1030 , discussion 1030–1031
  • 46 Buess G, Theiss R, Günther M, Hutterer F, Pichlmaier H. Transanal endoscopic microsurgery [in German]. Leber Magen Darm 1985; 15 (06) 271-279
  • 47 Atallah S, Albert M, Larach S. Transanal minimally invasive surgery: a giant leap forward. Surg Endosc 2010; 24 (09) 2200-2205
  • 48 Maglio R, Muzi GM, Massimo MM, Masoni L. Transanal minimally invasive surgery (TAMIS): new treatment for early rectal cancer and large rectal polyps—experience of an Italian center. Am Surg 2015; 81 (03) 273-277
  • 49 Martin-Perez B, Andrade-Ribeiro GD, Hunter L, Atallah S. A systematic review of transanal minimally invasive surgery (TAMIS) from 2010 to 2013. Tech Coloproctol 2014; 18 (09) 775-788
  • 50 McLemore EC, Weston LA, Coker AM. et al. Transanal minimally invasive surgery for benign and malignant rectal neoplasia. Am J Surg 2014; 208 (03) 372-381
  • 51 Khan N, Abboudi H, Khan MS, Dasgupta P, Ahmed K. Measuring the surgical 'learning curve': methods, variables and competency. BJU Int 2014; 113 (03) 504-508
  • 52 Cataldo PA. Transanal endoscopic microsurgery. Surg Clin North Am 2006; 86 (04) 915-925
  • 53 Maya A, Vorenberg A, Oviedo M, da Silva G, Wexner SD, Sands D. Learning curve for transanal endoscopic microsurgery: a single-center experience. Surg Endosc 2014; 28 (05) 1407-1412
  • 54 Barendse RM, Dijkgraaf MG, Rolf UR. et al. Colorectal surgeons' learning curve of transanal endoscopic microsurgery. Surg Endosc 2013; 27 (10) 3591-3602
  • 55 Chen N, Peng YF, Yao YF, Gu J. Trans-anal minimally invasive surgery for rectal neoplasia: Experience from single tertiary institution in China. World J Gastrointest Oncol 2018; 10 (06) 137-144
  • 56 Cid RC, Pérez JC, Elosua TG. et al. Transanal resection using a single port trocar: a new approach to NOTES [in Spanish]. Cir Esp 2011; 89 (01) 20-23
  • 57 Ragupathi M, Vande Maele D, Nieto J, Pickron TB, Haas EM. Transanal endoscopic video-assisted (TEVA) excision. Surg Endosc 2012; 26 (12) 3528-3535
  • 58 Lim SB, Seo SI, Lee JL. et al. Feasibility of transanal minimally invasive surgery for mid-rectal lesions. Surg Endosc 2012; 26 (11) 3127-3132
  • 59 Barendse RM, Doornebosch PG, Bemelman WA, Fockens P, Dekker E, de Graaf EJ. Transanal employment of single access ports is feasible for rectal surgery. Ann Surg 2012; 256 (06) 1030-1033
  • 60 Lee TG, Lee SJ. Transanal single-port microsurgery for rectal tumors: minimal invasive surgery under spinal anesthesia. Surg Endosc 2014; 28 (01) 271-280
  • 61 van den Boezem PB, Kruyt PM, Stommel MW, Tobon Morales R, Cuesta MA, Sietses C. Transanal single-port surgery for the resection of large polyps. Dig Surg 2011; 28 (5-6): 412-416
  • 62 Albert MR, Atallah SB, deBeche-Adams TC, Izfar S, Larach SW. Transanal minimally invasive surgery (TAMIS) for local excision of benign neoplasms and early-stage rectal cancer: efficacy and outcomes in the first 50 patients. Dis Colon Rectum 2013; 56 (03) 301-307
  • 63 Hahnloser D, Cantero R, Salgado G, Dindo D, Rega D, Delrio P. Transanal minimal invasive surgery for rectal lesions: should the defect be closed?. Colorectal Dis 2015; 17 (05) 397-402
  • 64 Keller DS, Tahilramani RN, Flores-Gonzalez JR, Mahmood A, Haas EM. Transanal minimally invasive surgery: review of indications and outcomes from 75 consecutive patients. J Am Coll Surg 2016; 222 (05) 814-822
  • 65 Lee L, Kelly J, Nassif GJ. et al. Establishing the learning curve of transanal minimally invasive surgery for local excision of rectal neoplasms. Surg Endosc 2018; 32 (03) 1368-1376
  • 66 Clermonts SHEM, van Loon YT, Stijns J, Pottel H, Wasowicz DK, Zimmerman DDE. The effect of proctoring on the learning curve of transanal minimally invasive surgery for local excision of rectal neoplasms. Tech Coloproctol 2018; 22 (12) 965-975
  • 67 Wolthuis AM, Cini C, Penninckx F, D'Hoore A. Transanal single port access to facilitate distal rectal mobilization in laparoscopic rectal sleeve resection with hand-sewn coloanal anastomosis. Tech Coloproctol 2012; 16 (02) 161-165
  • 68 Marks JH, Salem JF. From TATA to NOTES, how taTME fits into the evolutionary surgical tree. Tech Coloproctol 2016; 20 (08) 513-515
  • 69 Sylla P, Rattner DW, Delgado S, Lacy AM. NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 2010; 24 (05) 1205-1210
  • 70 de Lacy AM, Rattner DW, Adelsdorfer C. et al. Transanal natural orifice transluminal endoscopic surgery (NOTES) rectal resection: “down-to-up” total mesorectal excision (TME)--short-term outcomes in the first 20 cases. Surg Endosc 2013; 27 (09) 3165-3172
  • 71 de Lacy AM, Tasende MM, Delgado S. et al. Transanal total mesorectal excision for rectal cancer: outcomes after 140 patients. J Am Coll Surg 2015; 221 (02) 415-423
  • 72 de Lacy FB, van Laarhoven JJEM, Pena R. et al. Transanal total mesorectal excision: pathological results of 186 patients with mid and low rectal cancer. Surg Endosc 2018; 32 (05) 2442-2447
  • 73 Atallah S, Martin-Perez B, Pinan J. et al. Robotic transanal total mesorectal excision: a pilot study. Tech Coloproctol 2014; 18 (11) 1047-1053
  • 74 Atallah S, Martin-Perez B, Albert M. et al. Transanal minimally invasive surgery for total mesorectal excision (TAMIS-TME): results and experience with the first 20 patients undergoing curative-intent rectal cancer surgery at a single institution. Tech Coloproctol 2014; 18 (05) 473-480
  • 75 Sylla P, Bordeianou LG, Berger D. et al. A pilot study of natural orifice transanal endoscopic total mesorectal excision with laparoscopic assistance for rectal cancer. Surg Endosc 2013; 27 (09) 3396-3405
  • 76 Burke JP, Martin-Perez B, Khan A. et al. Transanal total mesorectal excision for rectal cancer: early outcomes in 50 consecutive patients. Colorectal Dis 2016; 18 (06) 570-577
  • 77 Penna M, Hompes R, Arnold S. et al; TaTME Registry Collaborative. Transanal total mesorectal excision: international registry results of the first 720 cases. Ann Surg 2017; 266 (01) 111-117
  • 78 Muratore A, Mellano A, Marsanic P, De Simone M. Transanal total mesorectal excision (taTME) for cancer located in the lower rectum: short- and mid-term results. Eur J Surg Oncol 2015; 41 (04) 478-483
  • 79 Chen WH, Kang L, Luo SL. et al. Transanal total mesorectal excision assisted by single-port laparoscopic surgery for low rectal cancer. Tech Coloproctol 2015; 19 (09) 527-534
  • 80 Buchs NC, Wynn G, Austin R. et al. A two-centre experience of transanal total mesorectal excision. Colorectal Dis 2016; 18 (12) 1154-1161
  • 81 Buchs NC, Nicholson GA, Yeung T. et al. Transanal rectal resection: an initial experience of 20 cases. Colorectal Dis 2016; 18 (01) 45-50
  • 82 Marks JH, Montenegro GA, Salem JF, Shields MV, Marks GJ. Transanal TATA/TME: a case-matched study of taTME versus laparoscopic TME surgery for rectal cancer. Tech Coloproctol 2016; 20 (07) 467-473
  • 83 Veltcamp Helbach M, Deijen CL, Velthuis S, Bonjer HJ, Tuynman JB, Sietses C. Transanal total mesorectal excision for rectal carcinoma: short-term outcomes and experience after 80 cases. Surg Endosc 2016; 30 (02) 464-470
  • 84 Chen CC, Lai YL, Jiang JK. et al. Transanal total mesorectal excision versus laparoscopic surgery for rectal cancer receiving neoadjuvant chemoradiation: a matched case-control study. Ann Surg Oncol 2016; 23 (04) 1169-1176
  • 85 Caycedo-Marulanda A, Jiang HY, Kohtakangas EL. Outcomes of a single surgeon-based transanal-total mesorectal excision (TATME) for rectal cancer. J Gastrointest Cancer 2018; 49 (04) 455-462
  • 86 Francis N, Penna M, Mackenzie H, Carter F, Hompes R. International TaTME Educational Collaborative Group. Consensus on structured training curriculum for transanal total mesorectal excision (TaTME). Surg Endosc 2017; 31 (07) 2711-2719
  • 87 Koedam TWA, Veltcamp Helbach M, van de Ven PM. et al. Transanal total mesorectal excision for rectal cancer: evaluation of the learning curve. Tech Coloproctol 2018; 22 (04) 279-287
  • 88 Caycedo-Marulanda A, Ma G, Jiang HY. Transanal total mesorectal excision (taTME) in a single-surgeon setting: refinements of the technique during the learning phase. Tech Coloproctol 2018; 22 (06) 433-443
  • 89 Penna M, Hompes R, Mackenzie H, Carter F, Francis NK. First international training and assessment consensus workshop on transanal total mesorectal excision (taTME). Tech Coloproctol 2016; 20 (06) 343-352
  • 90 Adamina M, Buchs NC, Penna M, Hompes R. St.Gallen Colorectal Consensus Expert Group. St. Gallen consensus on safe implementation of transanal total mesorectal excision. Surg Endosc 2018; 32 (03) 1091-1103
  • 91 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 (07) 483-494
  • 92 Ratcliffe F, Hogan AM, Hompes R. CO2 embolus: an important complication of TaTME surgery. Tech Coloproctol 2017; 21 (01) 61-62
  • 93 Barnes TG, Penna M, Hompes R, Cunningham C. Fluorescence to highlight the urethra: a human cadaveric study. Tech Coloproctol 2017; 21 (06) 439-444
  • 94 Ericsson KA. Acquisition and maintenance of medical expertise: a perspective from the expert-performance approach with deliberate practice. Acad Med 2015; 90 (11) 1471-1486
  • 95 Bedetti B, Schnorr P, Schmidt J, Scarci M. The role of wet lab in thoracic surgery. J Vis Surg 2017; 3: 61
  • 96 Haluck RS, Satava RM, Fried G. et al. Establishing a simulation center for surgical skills: what to do and how to do it. Surg Endosc 2007; 21 (07) 1223-1232
  • 97 Campbell ML, Vadas KJ, Rasheid SH, Marcet JE, Sanchez JE. A reproducible ex vivo model for transanal minimally invasive surgery. JSLS 2014; 18 (01) 62-65
  • 98 Aigner F, Biebl M, Fürst A, Jöns T, Pratschke J, Kneist W. Training course transanal total mesorectal excision (TaTME) : concept and establishment of a training course for safe application [in German]. Chirurg 2017; 88 (02) 147-154
  • 99 Wynn GR, Austin RCT, Motson RW. Using cadaveric simulation to introduce the concept and skills required to start performing transanal total mesorectal excision. Colorectal Dis 2018; 20 (06) 496-501
  • 100 Zhu E, Hadadgar A, Masiello I, Zary N. Augmented reality in healthcare education: an integrative review. PeerJ 2014; 2: e469
  • 101 Martin-Perez B, Bennis H, Lacy AM. Virtual reality simulation for surgery: from video games to transanal total mesorectal excision. Tech Coloproctol 2018; 22 (01) 5-6
  • 102 Alaker M, Wynn GR, Arulampalam T. Virtual reality training in laparoscopic surgery: a systematic review & meta-analysis. Int J Surg 2016; 29: 85-94
  • 103 Beyer-Berjot L, Berdah S, Hashimoto DA, Darzi A, Aggarwal R. A virtual reality training curriculum for laparoscopic colorectal surgery. J Surg Educ 2016; 73 (06) 932-941
  • 104 Sahnan K, Adegbola SO, Tozer PJ. et al. Innovation in the imaging perianal fistula: a step towards personalised medicine. Therap Adv Gastroenterol 2018; 11: 1756284818775060
  • 105 Pellino G, García-Granero A, Fletcher-Sanfeliu D. et al. Preoperative surgical planning based on cadaver simulation and 3D imaging for a retrorectal tumour: description and video demonstration. Tech Coloproctol 2018; 22 (09) 709-713
  • 106 Franchini Melani AG, Diana M, Marescaux J. The quest for precision in transanal total mesorectal excision. Tech Coloproctol 2016; 20 (01) 11-18
  • 107 Atallah S, Nassif G, Larach S. Stereotactic navigation for TAMIS-TME: opening the gateway to frameless, image-guided abdominal and pelvic surgery. Surg Endosc 2015; 29 (01) 207-211
  • 108 Atallah S, Larach SW, Monson JR. Stereotactic navigation for TAMIS-TME. Minim Invasive Ther Allied Technol 2016; 25 (05) 271-277
  • 109 Knol J, Bonjer J, Houben B. et al. New paradigm of live surgical education: synchronized deferred live surgery. J Am Coll Surg 2018; 227 (04) 467-473
  • 110 Andersen DK. How can educators use simulation applications to teach and assess surgical judgment?. Acad Med 2012; 87 (07) 934-941
  • 111 Knol J, Chadi SA. Transanal total mesorectal excision: technical aspects of approaching the mesorectal plane from below. Minim Invasive Ther Allied Technol 2016; 25 (05) 257-270