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Current Challenges for Education and Training in Transanal Surgery
1Department of Colorectal Surgery, University Hospitals Ahuja Medical Center, Beachwood, Ohio.
Clinics in Colon and Rectal Surgery
|April 5, 2021
Summary
Transanal endoscopic microsurgery (TEM) training is evolving for total mesorectal excision (taTME). Strict guidelines ensure surgeon proficiency to minimize oncologic risks during this advanced rectal surgery technique.
Area of Science:
- Colorectal Surgery
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Transanal endoscopic microsurgery (TEM) initially improved access for upper rectal polyps.
- Advancements allow TEM for complete rectal removal, known as transanal total mesorectal excision (taTME).
- taTME presents higher oncologic risks compared to TEM for benign conditions.
Purpose of the Study:
- To establish consensus guidelines for surgeon training in taTME.
- To ensure patient safety and optimize outcomes during the adoption of taTME.
Main Methods:
- Surgeons should have prior laparoscopic TME experience.
- Formal training courses and proctored initial cases are recommended.
- Prospective monitoring of morbidity, oncologic, and functional outcomes is crucial.
Main Results:
- Consensus guidelines emphasize specific training prerequisites for taTME surgeons.
- Training focuses on gradual progression from benign to malignant cases.
- Proctored procedures and outcome monitoring are integral to proficiency.
Conclusions:
- Strict training criteria are essential for safe and effective taTME implementation.
- Adherence to guidelines minimizes potential oncologic consequences for patients.
- Standardized training ensures surgeon competency in advanced rectal surgery.