Transanal Total Mesorectal (taTME) Excision in Rectal Cancer

Transanal total mesorectal excision (taTME) constitutes a novel approach for the radical removal of the rectum. The procedure was designed to take advantage of the natural orifice surgery concept; it allows for the bottom-up dissection of the rectum through the insertion of either a flexible or rigid transanal platform. Historically, removal of the rectum represents a technical challenge due to the anatomical constraints posed by the rigid pelvis. The procedure gathered great interest from surgeons across the world; this ultimately met significant scrutiny after the publication of a local moratorium from Norway. The procedure is done by either a sequential or a synchronous approach with single or dual teams, respectively. Surgeons can use specifically designed equipment or adapt laparoscopic instruments for this procedure. Standardization of the procedure for the learning and safe implementation of the procedure have not been agreed upon. Despite having mastered the technique, the authors recognize that taTME has the potential for devastating and otherwise infrequent complications; therefore extreme caution is recommended if a decision is made to embark in the implementation of taTME. We present our perspective and experience on this complex intervention.