Download PDF
Clin Colon Rectal Surg 2021; 34(03): 151-154
DOI: 10.1055/s-0040-1718684
Review Article

Current Challenges for Education and Training in Transanal Surgery

Meagan Costedio
1   Department of Colorectal Surgery, University Hospitals Ahuja Medical Center, Beachwood, Ohio
2   Department of Colorectal Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Transanal endoscopic microsurgery (TEM) is a technique that was introduced in the 1980s for improved exposure to upper rectal polyps. This technique, though initially difficult to master due to new skill acquisition for surgeons, has spared many patients proctectomy. There are many benign indications for transanal endoscopic surgery which has led to in vivo operating room training with fewer undesirable effects to the patient. With the explosion of laparoscopic technology this transanal technique is no longer limited to intraluminal pathology, but is now being used to remove the entire rectum. In transanal total mesorectal excision (taTME), benign indications are less common, translating to potentially more severe oncologic patient consequences during the early phase of adoption. For this reason, strict training criteria consensus guidelines have been developed by the experts in taTME. The current consensus statements agree that training surgeons should have performed a minimum of 10 laparoscopic TME procedures and should have some experience with transanal surgery. Surgeons need to attend a formal training course and should start clinically on benign or early malignant pathology without threated circumferential resection margins. Surgeons also need to have their first cases proctored until deemed proficient by the proctor and monitor their morbidity, oncologic, and functional outcomes prospectively.

Keywords

transanal endoscopic surgery (TES) - education - learning curve - training - transanal total mesorectal excision - taTME


Publication History

Article published online:
29 March 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Moore JS, Cataldo PA, Osler T, Hyman NH. Transanal endoscopic microsurgery is more effective than traditional transanal excision for resection of rectal masses. Dis Colon Rectum 2008; 51 (07) 1026-1030 , discussion 1030–1031
    CrossrefPubMedGoogle Scholar
  • 2 Christoforidis D, Cho H-M, Dixon MR, Mellgren AF, Madoff RD, Finne CO. Transanal endoscopic microsurgery versus conventional transanal excision for patients with early rectal cancer. Ann Surg 2009; 249 (05) 776-782
    CrossrefPubMedGoogle Scholar
  • 3 Buess G, Theiss R, Hutterer F. et al. Transanal endoscopic surgery of the rectum - testing a new method in animal experiments [in German]. Leber Magen Darm 1983; 13 (02) 73-77
    PubMedGoogle Scholar
  • 4 Buess G, Kipfmüller K, Ibald R. et al. Clinical results of transanal endoscopic microsurgery. Surg Endosc 1988; 2 (04) 245-250
    CrossrefPubMedGoogle Scholar
  • 5 Kipfmüller K, Buess G, Naruhn M, Junginger T. Training program for transanal endoscopic microsurgery. Surg Endosc 1988; 2 (01) 24-27
    CrossrefPubMedGoogle Scholar
  • 6 Emmanuel A, Gulati S, Burt M, Hayee B, Haji A. Safe and effective endoscopic resection of massive colorectal adenomas ≥8 cm in a tertiary referral center. Dis Colon Rectum 2018; 61 (08) 955-963
    CrossrefPubMedGoogle Scholar
  • 7 Serra-Aracil X, Gràcia R, Mora-López L. et al. How to deal with rectal lesions more than 15 cm from the anal verge through transanal endoscopic microsurgery. Am J Surg 2019; 217 (01) 53-58
    CrossrefPubMedGoogle Scholar
  • 8 Serra-Aracil X, Mora-Lopez L, Alcantara-Moral M, Corredera-Cantarin C, Gomez-Diaz C, Navarro-Soto S. Atypical indications for transanal endoscopic microsurgery to avoid major surgery. Tech Coloproctol 2014; 18 (02) 157-164
    CrossrefPubMedGoogle Scholar
  • 9 Whiteford MH, Denk PM, Swanström LL. Feasibility of radical sigmoid colectomy performed as natural orifice translumenal endoscopic surgery (NOTES) using transanal endoscopic microsurgery. Surg Endosc 2007; 21 (10) 1870-1874
    CrossrefPubMedGoogle Scholar
  • 10 Sylla P, Sohn DK, Cizginer S. et al. Survival study of natural orifice translumenal endoscopic surgery for rectosigmoid resection using transanal endoscopic microsurgery with or without transgastric endoscopic assistance in a swine model. Surg Endosc 2010; 24 (08) 2022-2030
    CrossrefPubMedGoogle Scholar
  • 11 Sylla P, Rattner DW, Delgado S, Lacy AM. NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 2010; 24 (05) 1205-1210
    CrossrefPubMedGoogle Scholar
  • 12 Veltcamp Helbach M, Deijen CL, Velthuis S, Bonjer HJ, Tuynman JB, Sietses C. Transanal total mesorectal excision for rectal carcinoma: short-term outcomes and experience after 80 cases. Surg Endosc 2016; 30 (02) 464-470
    CrossrefPubMedGoogle Scholar
  • 13 Atallah S, Martin-Perez B, Albert M. et al. Transanal minimally invasive surgery for total mesorectal excision (TAMIS-TME): results and experience with the first 20 patients undergoing curative-intent rectal cancer surgery at a single institution. Tech Coloproctol 2014; 18 (05) 473-480
    CrossrefPubMedGoogle Scholar
  • 14 Lacy AM, Tasende MM, Delgado S. et al. Transanal total mesorectal excision for rectal cancer: outcomes after 140 patients. J Am Coll Surg 2015; 221 (02) 415-423
    CrossrefPubMedGoogle Scholar
  • 15 Helewa R, Rajaee A, Raice I. et al. The implementation of a transanal endoscopic microsurgery programme: initial experience with surgical performance. Colorectal Dis 2016; 18 (11) 1057-1062
    CrossrefPubMedGoogle Scholar
  • 16 Barendse RM, Dijkgraaf MG, Rolf UR. et al. Colorectal surgeons' learning curve of transanal endoscopic microsurgery. Surg Endosc 2013; 27 (10) 3591-3602
    CrossrefPubMedGoogle Scholar
  • 17 Slack T, Wong S, Muhlmann M. Transanal minimally invasive surgery: an initial experience. ANZ J Surg 2014; 84 (03) 177-180
    CrossrefPubMedGoogle Scholar
  • 18 Lee L, Kelly J, Nassif GJ. et al. Establishing the learning curve of transanal minimally invasive surgery for local excision of rectal neoplasms. Surg Endosc 2018; 32 (03) 1368-1376
    CrossrefPubMedGoogle Scholar
  • 19 Ma B, Gao P, Song Y. et al. Transanal total mesorectal excision (taTME) for rectal cancer: a systematic review and meta-analysis of oncological and perioperative outcomes compared with laparoscopic total mesorectal excision. BMC Cancer 2016; 16: 380
    CrossrefPubMedGoogle Scholar
  • 20 COLOR III trial protocol. Accessed on January 13, 2021 at: http://color3trial.com
    PubMedGoogle Scholar
  • 21 Rouanet P, Mourregot A, Azar CC. et al. Transanal endoscopic proctectomy: an innovative procedure for difficult resection of rectal tumors in men with narrow pelvis. Dis Colon Rectum 2013; 56 (04) 408-415
    CrossrefPubMedGoogle Scholar
  • 22 Atallah S. Transanal total mesorectal excision: full steam ahead. Tech Coloproctol 2015; 19 (02) 57-61
    CrossrefPubMedGoogle Scholar
  • 23 Burke JP, Martin-Perez B, Khan A. et al. Transanal total mesorectal excision for rectal cancer: early outcomes in 50 consecutive patients. Colorectal Dis 2016; 18 (06) 570-577
    CrossrefPubMedGoogle Scholar
  • 24 Penna M, Hompes R, Arnold S. et al; TaTME Registry Collaborative. Transanal total mesorectal excision: international registry results of the first 720 cases. Ann Surg 2017; 266 (01) 111-117
    CrossrefPubMedGoogle Scholar
  • 25 Deijen CL, Tsai A, Koedam TWA. et al. Clinical outcomes and case volume effect of transanal total mesorectal excision for rectal cancer: a systematic review. Tech Coloproctol 2016; 20 (12) 811-824
    CrossrefPubMedGoogle Scholar
  • 26 Atallah SB, DuBose AC, Burke JP. et al. Uptake of transanal total mesorectal excision in North America: initial assessment of a structured training program and the experience of delegate surgeons. Dis Colon Rectum 2017; 60 (10) 1023-1031
    CrossrefPubMedGoogle Scholar
  • 27 Motson RW, Whiteford MH, Hompes R, Albert M, Miles WFA. Expert Group. Current status of trans-anal total mesorectal excision (TaTME) following the Second International Consensus Conference. Colorectal Dis 2016; 18 (01) 13-18
    CrossrefPubMedGoogle Scholar
  • 28 Maykel JA, Phatak UR, Suwanabol PA. et al. Initiation of a transanal total mesorectal excision program at an academic training program: evaluating patient safety and quality outcomes. Dis Colon Rectum 2017; 60 (12) 1267-1272
    CrossrefPubMedGoogle Scholar
  • 29 Francis N, Penna M, Mackenzie H, Carter F, Hompes R. International TaTME Educational Collaborative Group. Consensus on structured training curriculum for transanal total mesorectal excision (TaTME). Surg Endosc 2017; 31 (07) 2711-2719
    CrossrefPubMedGoogle Scholar
  • 30 Adamina M, Buchs NC, Penna M, Hompes R. St. Gallen Colorectal Consensus Expert Group. St. Gallen consensus on safe implementation of transanal total mesorectal excision. Surg Endosc 2018; 32 (03) 1091-1103
    CrossrefPubMedGoogle Scholar
  • 31 Helewa RM, Rajaee AN, Raiche I. et al. The implementation of a transanal endoscopic microsurgery programme: initial experience with surgical performance. Colorectal Dis 2016; 18 (11) 1057-1062
    CrossrefPubMedGoogle Scholar