Transanal Total Mesorectal Excision: A Novel Approach to Rectal Surgery

AbstractTransanal total mesorectal excision (taTME) has evolved over the past decade fueled by advances in minimally invasive surgery. The technique aims to overcome the constraints posed by a narrow rigid pelvis and poor TME visualization that are encountered during “top-down” rectal surgery. A more accurate pelvic dissection should subsequently result in safer oncological resections and better preservation of pelvic autonomic nerves. taTME is an advanced complex technique that requires dedicated training and experience in TME surgery. Initial results from small cohorts are promising and confirmation by randomized controlled trials is eagerly awaited.

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The role of transanal total mesorectal excision in rectal surgery

Mini-invasive Surgery ◽

10.20517/2574-1225.2018.17 ◽

2018 ◽

Vol 2 (8) ◽

pp. 22

Author(s):

Shlomo Yellinek ◽

Steven D. Wexner

Keyword(s):

Total Mesorectal Excision ◽

Rectal Surgery ◽

Transanal Total Mesorectal Excision ◽

Mesorectal Excision

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Clinical Status and Future Prospects of Transanal Total Mesorectal Excision

Frontiers in Oncology ◽

10.3389/fonc.2021.752737 ◽

2022 ◽

Vol 11 ◽

Author(s):

Zichao Guo ◽

Xiaopin Ji ◽

Shaodong Wang ◽

Yaqi Zhang ◽

Kun Liu ◽

...

Keyword(s):

Rectal Cancer ◽

Total Mesorectal Excision ◽

Resection Margin ◽

Clinical Status ◽

Radical Resection ◽

Low Rectal Cancer ◽

Transanal Total Mesorectal Excision ◽

Mesorectal Excision ◽

Promising Alternative ◽

Novel Approach

Low rectal cancer has always posed surgical challenges to gastrointestinal surgeons. Transanal total mesorectal excision (taTME) is a novel approach to radical resection for low rectal cancer. Compared with conventional laparoscopic TME (laTME), taTME is relevant to the benefits of better vision of the mesorectal plane, feasibility of operating in a narrow pelvis, and exact definition of distal resection margin, which may lead to a higher possibility of free circumferential resection margin, better quality of TME specimen, and lower conversion rate. Although there are concerns about its long-term oncological outcomes and complex learning curve, taTME is a promising alternative for rectal cancer. In this review, we discuss the application status and prospects of taTME.

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Combined robotic transanal total mesorectal excision (R-taTME) and single-site plus one-port (R-SSPO) technique for ultra-low rectal surgery—initial experience with a new operation approach

International Journal of Colorectal Disease ◽

10.1007/s00384-016-2686-3 ◽

2016 ◽

Vol 32 (2) ◽

pp. 249-254 ◽

Cited By ~ 21

Author(s):

Li-Jen Kuo ◽

James Chi-Yong Ngu ◽

Yiu-Shun Tong ◽

Chia-Che Chen

Keyword(s):

Total Mesorectal Excision ◽

Rectal Surgery ◽

Single Site ◽

Transanal Total Mesorectal Excision ◽

Initial Experience ◽

Mesorectal Excision ◽

Robotic Transanal

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Wasmuth HH, Færden AE, Myklebust TÅ, et al (2020) Transanal total mesorectal excision for rectal cancer has been suspended in Norway. Br J Surg 107:121–30

Côlon & Rectum ◽

10.3166/cer-2020-0146 ◽

2020 ◽

Vol 14 (3) ◽

pp. 155-158

Author(s):

M. Aubert ◽

Y. Panis

Keyword(s):

Rectal Cancer ◽

Total Mesorectal Excision ◽

Cancer Du Rectum ◽

Prise En Charge ◽

Transanal Total Mesorectal Excision ◽

Mesorectal Excision ◽

Récidive Locale ◽

Kaplan Meier ◽

Cancers Colorectaux ◽

Technique Chirurgicale

Contexte : L’exérèse totale du mésorectum par voie transanale (TaTME) pour la prise en charge du cancer du rectum est récemment apparue comme alternative à l’exérèse totale du mésorectum par voie abdominale. Cependant, certaines inquiétudes à propos des résultats oncologiques de cette technique chirurgicale ont émergé. Le but de cette étude était d’évaluer le taux de récidives locales après TaTME. Les objectifs secondaires s’intéressaient à la mortalité postopératoire, au taux de fistule anastomotique et au taux de stomie définitive. Méthodes : Les données de tous les patients opérés par TaTME ont été rapportées et comparées aux données issues des registres nationaux norvégiens de cancers colorectaux (NCCR) et de chirurgie gastro-intestinale (NoRGast). Les taux de récidive locale étaient estimés selon Kaplan-Meier. Résultats : En Norvège, 157 patients ont été opérés par TaTME pour un cancer du rectum entre octobre 2014 et octobre 2018. Trois des sept centres hospitaliers participants ont abandonné la réalisation de cette intervention après cinq procédures. Le taux de récidive locale était de 12 sur 157 patients (7,6 %) ; huit récidives locales étaient multifocales ou étendues. Le taux de récidive locale après un suivi de à 2,4 ans était estimé à 11,6 % (IC 95 % : [6,6‒19,9]) après TaTME contre 2,4 % (IC 95 % : [1,4‒4,4]) dans le registre NCCR (p < 0,001). Le hasard ratio était estimé à 6,71 (IC 95 % : [2,94‒15,32]). Le taux de fistule anastomotique nécessitant une réintervention était de 8,4 % dans le groupe TaTME contre 4,5 % dans le registre NoRGast (p = 0,047). Cinquante-six patients (35,7 %) étaient porteurs d’une stomie à la fin du suivi, dont 39 (24,8 %) étaient définitives. Conclusion : Le taux de fistule anastomotique était plus élevé après TaTME en comparaison aux données des registres nationaux norvégiens. Le taux de récidive locale ainsi que les caractéristiques de cette récidive après TaTME étaient défavorables.

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Deep learning-based automatic surgical step recognition in intraoperative videos for transanal total mesorectal excision

Surgical Endoscopy ◽

10.1007/s00464-021-08381-6 ◽

2021 ◽

Author(s):

Daichi Kitaguchi ◽

Nobuyoshi Takeshita ◽

Hiroki Matsuzaki ◽

Hiro Hasegawa ◽

Takahiro Igaki ◽

...

Keyword(s):

Deep Learning ◽

Total Mesorectal Excision ◽

Rectal Wall ◽

Learning Model ◽

Video Indexing ◽

Video Data ◽

Transanal Total Mesorectal Excision ◽

Mesorectal Excision ◽

Purse String ◽

Deep Learning Model

Abstract Background Dividing a surgical procedure into a sequence of identifiable and meaningful steps facilitates intraoperative video data acquisition and storage. These efforts are especially valuable for technically challenging procedures that require intraoperative video analysis, such as transanal total mesorectal excision (TaTME); however, manual video indexing is time-consuming. Thus, in this study, we constructed an annotated video dataset for TaTME with surgical step information and evaluated the performance of a deep learning model in recognizing the surgical steps in TaTME. Methods This was a single-institutional retrospective feasibility study. All TaTME intraoperative videos were divided into frames. Each frame was manually annotated as one of the following major steps: (1) purse-string closure; (2) full thickness transection of the rectal wall; (3) down-to-up dissection; (4) dissection after rendezvous; and (5) purse-string suture for stapled anastomosis. Steps 3 and 4 were each further classified into four sub-steps, specifically, for dissection of the anterior, posterior, right, and left planes. A convolutional neural network-based deep learning model, Xception, was utilized for the surgical step classification task. Results Our dataset containing 50 TaTME videos was randomly divided into two subsets for training and testing with 40 and 10 videos, respectively. The overall accuracy obtained for all classification steps was 93.2%. By contrast, when sub-step classification was included in the performance analysis, a mean accuracy (± standard deviation) of 78% (± 5%), with a maximum accuracy of 85%, was obtained. Conclusions To the best of our knowledge, this is the first study based on automatic surgical step classification for TaTME. Our deep learning model self-learned and recognized the classification steps in TaTME videos with high accuracy after training. Thus, our model can be applied to a system for intraoperative guidance or for postoperative video indexing and analysis in TaTME procedures.

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