Anatomical Study for Transanal Total Mesorectal Excision in Cadaveric Surgical Training

BackgroundThis study reported on cadaveric surgical training (CST) focusing on the anatomical knowledge necessary for transanal total mesorectal excision (TaTME) and educational perspective on our experiences.Methods3 CSTs were conducted with a total of 6 male cadavers between 2018 and 2020. Anatomical findings were collected from CSTs. All steps of the TaTME process were timed. Specimens were transanally or transabdominally extracted. The trainer rated the total mesorectal excision (TME) quality as complete, near complete, or incomplete.ResultsThe number of trainees were 6 surgeons. Their number of years since graduation was 9 (6-19), their experience with conventional TME on live patients was 46 cases (27-202), and their experience with TaTME on live patients was 0 case (0-4). Their set up of the transanal platform was 14 min (7-21), time to resect the anococcygeal ligament was 17 min (6-29), time to resect the retrourethral muscle was 23 min (9-41), time to spare fourth pelvic splanchnic nerves was 11 min (4-28), and total completion of the TaTME was 84 min (59-122). The grade of TME was incomplete in 1 case (11.1%), nearly complete in 1 case (11.1%), and complete in 7 cases (77.8%).ConclusionIn this study, the anatomical structures necessary for TaTME were identified. We believe that CST for TaTME is a promising educational method for overcoming and performing the characteristic anatomical challenges safely.