Dr. Antonio M. Lacy, Professor of Surgery and Chief of Gastrointestinal Surgery at Hospital Clinic in Barcelona, Spain, explains some technical tips to identify and avoid the pitfalls of the transanal total mesorectal excision (TaTME).
He discusses the controversy between the one- and two-team approach, and divides the procedure into two stages (abdominal and transanal). As the abdominal stage is similar to a sigmoidectomy, he focuses on the transanal part. The devices required, such as a continuous flow insufflator and a 3D scope are discussed.
Dr. Lacy provides information on to perform the perfect TaTME, discussing the differences between the high rectum and low rectum. Tips on how to place the transanal platform, the purse string, the mucosal tattoo, and rectal dissection are also given. How to avoid urethral and vaginal damage is discussed. The importance of indocyanine green assessment of the anastomosis is underlined with data from Dr. Lacy’s team.
Finally, the latest literature results on TaTME are discussed and data from the Barcelona team on the short and mid-term outcomes and the oncological outcomes is explained.