TaTME, training, guidance and monitoring towards safe introduction of the TATME technique  

 

Transanal reversed Total mesorectal excision (TaTME) has had tremendous exposure and attention since its introduction in 2011 by lacy et al. The TaTME technique has been developed with use of laparoscopic single port platforms to improve the quality of the TME procedure in mid and low rectal cancer. In TaTME, the low pelvic mesorectum is distally approached through the anus facilitating better quality dissection of the distal mesorectum with adequate visual determination of the distal resection margin. Potentially the technique offers more precise dissection with higher rate of complete  specimens and low rate of involved circumferential resection margin (CRM) for low and mid rectal cancer.  The relative new surgical technique TaTME has shown in cohort series to achieve low CRM involvement and good specimen quality in experienced centres. However, randomised clinical trials investigating this new technique are lacking.

Despite its potential benefits and the enthusiastic uptake of the technique concern exists if it is safe for widespread adaptation.  TATME is relatively complex and possibly a long learning curve will hamper introduction of the Technique. Although the early adaptors of the technique have shown favourable results, new serious complications have also been published especially in low volume cohorts. Urethra injury or pelvic side wall injury with bleeding and nerve damage are complications which have not been documented for the conventional low anterior resection .  Inadequate training can hamper clinical outcome including rectal wall perforations, potential tumor spill and  increased incidence presacral abscesses.  Therefore the introduction of the TatME technique should be accompanied with training, guidance and monitoring

The TaTME collaborative group consisting of TaTME  experienced surgeons have made consensus about the safe introduction of this technique  towards clinical practice. Careful , training, guidance and monitoring is essential to avoid suboptimal clinical outcome which will hamper further introduction of this technique. The collaborative group agrees that the TatME procedure should be introduced within a randomised trial to gather high quality evidence.  The COLORIII will be launched in the end of 2015 and already has widespread acceptance in multiple centres all over te world. Before the trial will be launched all it is advised to collect case data in the central TaTME registry by www Lorec.uk.co

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