[Prerequisites for Safe Implementation of Transanal Total Mesorectal Excision]

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Minimally Invasive Procedures

Background:

• Transanal total mesorectal excision (TaTME) is an advanced surgical technique for rectal cancer.
• Its complexity necessitates clear prerequisites and training guidelines for safe adoption.

Purpose of the Study:

• To summarize international consensus on TaTME training requirements.
• To share experiences from cadaveric training and initial clinical series.
• To provide recommendations for safe implementation of TaTME.

Main Methods:

• Review of international consensus statements and surveys from training centers.
• Analysis of mentored cadaveric training courses (video).
• Evaluation of an initial clinical series of 102 TaTME procedures.

Main Results:

• Postgraduate colorectal surgeons should perform TaTME after mandatory structured training.
• Cadaver training and proctoring are crucial for safe implementation.
• A learning phase of at least 40 operations is indicated, with reduced morbidity (29% to 9%) and acceptable specimen quality thereafter.
• High-volume centers performing ≥20 TaTMEs annually are recommended for selected patients with multiple risk factors.

Conclusions:

• Structured training programs and proctoring are essential for safe TaTME implementation.
• Case volume and patient selection are critical factors for success.
• TaTME should be concentrated in high-volume centers to optimize outcomes for rectal cancer patients.