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Yellinek et al. Mini-invasive Surg 2018;2:22 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2018.17

Review Open Access

The role of transanal total mesorectal excision in
rectal surgery

Shlomo Yellinek, Steven D. Wexner

Cleveland Clinic Florida, Department of Colorectal Surgery, Weston, FL 33331, USA.
Correspondence to: Dr. Steven D. Wexner, Cleveland Clinic Florida, Department of Colorectal Surgery, 2950 Cleveland Clinic
Blvd., Weston, FL 33331, USA. E-mail: wexners@ccf.org
How to cite this article: Yellinek S, Wexner SD. The role of transanal total mesorectal excision in rectal surgery. Mini-invasive
Surg 2018;2:22. http://dx.doi.org/10.20517/2574-1225.2018.17
Received: 10 Apr 2018 First Decision: 21 Jun 2018 Revised: 18 Jul 2018 Accepted: 20 Jul 2018 Published: 2 Aug 2018

Science Editor: Gordon N. Buchanan Copy Editor: Jun-Yao Li Production Editor: Huan-Liang Wu

Abstract
Transanal total mesorectal excision (TaTME) is the newest approach for the resection of rectal cancer, according to
the principles of TME. The evolution of TaTME started almost 40 years ago and is a combination of several important
developments in both micro-endoscopic surgery and transanal surgery. The preliminary clinical data have revealed
acceptable TME quality. Clinical trials to determine the long-term oncological results are still in process. In order
to master TaTME, the surgeon should be an expert in laparoscopic rectal surgery as well as transanal microsurgery
and follow a stepwise training approach. Robotic TaTME using a single-port robotic system is a promising future
development.

Keywords: Transanal total mesorectal excision, rectal cancer, single port robotic proctectomy, transanal total mesorectal
incision training

INTRODUCTION AND HISTORY
The evolution of transanal total mesorectal excision (TaTME) began with the introduction of TME by
[1]
Heald et al. . In 1982, they showed a reduction in the local recurrence rate from 40% to < 10% by employ-
ing TME. Components of TME include a complete or near complete rather than an incomplete mesorectal
specimen, tumor-free circumferential resection margins (CRM), a tumor-free distal resection margin
(DRM), and the assessment of ≥ 12 lymph nodes. Initially, the operation was done in an open, trans-ab-
[2]
dominal approach. In 1991, Marks et al. presented the transabdominal-transanal (TATA) approach to low
rectal cancer. Dr. Marks’ rationale was that the transanal approach allows the surgeon to achieve distal re-
section margins under direct visualization and facilitates distal dissection . The next step in the evolution
[2]
© The Author(s) 2018. 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
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