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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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