[How to standardize transanal total mesorectum excision].

Area of Science:

• Colorectal surgery
• Surgical oncology
• Minimally invasive surgery

Background:

• Transanal total mesorectum excision (taTME) is an emerging surgical technique for rectal cancer.
• Standardization is essential for surgeons adopting taTME, particularly during initial attempts.

Purpose of the Study:

• To provide a comprehensive guide for colorectal surgeons on standardizing transanal total mesorectum excision (taTME).
• To facilitate earlier adoption of taTME, reduce the learning curve, and minimize complications.

Main Methods:

• Discussion of preoperative preparation, including patient selection criteria (e.g., female, age <70, tumor distance 5-7 cm, size <3 cm, cTNM
• Overview of necessary surgical instruments (laparoscopic equipment, anal retractor, insufflator).
• Description of operative approaches: pure, combined laparoscopic hybrid, and sequential hybrid taTME, highlighting the combined approach's ease of performance.

Main Results:

• The combined laparoscopic-transanal approach is noted as easier to perform.
• taTME offers advantages of less invasiveness and faster postoperative recovery, aligning with enhanced recovery after surgery (ERAS) principles.

Conclusions:

• Successful taTME requires mastery of laparoscopic skills, pelvic anatomy, and clear knowledge of the procedure.
• Adherence to standardized protocols in patient selection, instrumentation, and surgical technique can lead to improved patient outcomes and benefits.