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Yap et al. Mini-invasive Surg 2019;3:3                         Mini-invasive Surgery
               DOI: 10.20517/2574-1225.2018.57




               Review                                                                        Open Access


               Transanal total mesorectal excision: current updates

               Raymond Yap, John Monson

               Center for Colon & Rectal Surgery, Florida Hospital, Orlando, FL 32804, USA.

               Correspondence to: Dr. John Monson, Center for Colon& Rectal Surgery, Florida Hospital, 2415 North Orange Avenue, Suite
               300 Orlando, Orlando, FL 32804, USA. E-mail: john.monson.md@flhosp.org

               How to cite this article: Yap R, Monson J. Transanal total mesorectal excision: current updates. Mini-invasive Surg 2019;3:3.
               http://dx.doi.org/10.20517/2574-1225.2018.57
               Received: 14 Aug 2018    First Decision: 12 Nov 2018    Revised: 7 Jan 2019    Accepted: 14 Jan 2019    Published: 13 Feb 2019

               Science Editor: Gordon N. Buchanan    Copy Editor: Cui Yu    Production Editor: Huan-Liang Wu



               Abstract
               Transanal total mesorectal excision (TaTME) is the latest in a long list of developments in the surgical treatment of low
               rectal cancer. This article describes the evolution of the technique, a brief summation of the technical procedure, the
               current literature into its results, and the possible future direction that it might take. It is the authors’ opinion that TaTME
               will form another technique within the modern colorectal surgeon’s armament.


               Keywords: Transanal total mesorectal excision, transanal, rectal cancer




               INTRODUCTION
               The evolution of dedicated surgical techniques in the treatment of rectal cancer over the past century is
                                                                                                       [1]
               one of fascinating progress. The concept of the total removal of the mesocolon as described by Miles  is
               the foundation of one of the most important principles in rectal cancer surgery today; that is the complete
                                                                                      [2]
               removal of both the primary cancer and any associated lymph nodes. Heald et al.  then emphasized the
               idea of the “holy plane”, when he described total mesorectal excision as sharp dissection along a definable
               avascular tissue plane to remove the rectum and the mesorectum in an intact envelope.

               The achievement of this goal in rectal surgery is often not straightforward. Obtaining adequate trans-
               abdominal access to the deep pelvis for cases of mid to low rectal cancer continues to challenge even the
               most experienced of colorectal surgeons. This is made more difficult in a subset of patients, namely those
               who are obese, male, and with a narrow pelvis. Numerous techniques over the years have been developed to
               try and combat these challenges, although usually without overwhelming success or widespread adoption.



                           © The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
                           International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
                sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
                as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
                and indicate if changes were made.


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