Consensus on structured training curriculum for transanal total mesorectal excision (TaTME)

Abstract

BackgroundThe interest and adoption of transanal total mesorectal excision (TaTME) is growing amongst the colorectal surgical community, but there is no clear guidance on the optimal training framework to ensure safe practice for this novel operation. The aim of this study was to establish a consensus on a detailed structured training curriculum for TaTME. MethodsA consensus process to agree on the framework of the TaTME training curriculum was conducted, seeking views of 207 surgeons across 18 different countries, including 52 international experts in the field of TaTME. The process consisted of surveying potential learners of this technique, an international experts workshop and a final expert's consensus to draw an agreement on essential elements of the curriculum. ResultsAppropriate case selection was strongly recommended, and TaTME should be offered to patients with mid and low rectal cancers, but not proximal rectal cancers. Pre-requisites to learn TaTME should include completion of training and accreditation in laparoscopic colorectal surgery, with prior experience in transanal surgery. Ideally, two surgeons should undergo training together in centres with high volume for rectal cancer surgery. Mentorship and multidisciplinary training were the two most important aspects of the curriculum, which should also include online modules and simulated training for purse-string suturing. Mentors should have performed at least 20 TaTME cases and be experienced in laparoscopic training. Reviewing the specimens' quality, clinical outcome data and entering data into a registry were recommended. Assessment should be an integral part of the curriculum using Global Assessment Scales, as formative assessment to promote learning and competency assessment tool as summative assessment. ConclusionsA detailed framework for a structured TaTME training curriculum has been proposed. It encompasses various training modalities and assessment, as well as having the potential to provide quality control and future research initiatives for this novel technique.

Spin in articles about minimally invasive transanal total mesorectal excision: an assessment of the current literature

“…in higher‐impact surgical journals . On the contrary, we have seen a number of publications in the published literature from surgeons emphasizing the need for a careful, algorithmic and proctored approach to the introduction of TaTME into one's surgical practice, including training pathways and methods of self‐evaluation and assessment . This technique represents a new approach to rectal surgery with less familiar planes and a different procedural morbidity profile .…”

Transanal TME: new standard or fad?

“…taTME is a technically demanding procedure, and so appropriate education and training for performing this procedure is vital for safe adoption of this technique 39) . The International TaTME Education Collaborative has published training guidelines 40) . The guidelines recommend step-bystep acquisition of the technique skills as follows: selflearning; training; proctorship; and then independent practice.…”

The role of transanal total mesorectal excision in rectal surgery

“…Those specific complications and difficulties highlight the need for structured and accredited training program. Several authors have addressed the proper training pathway to the incorporation of TaTME into clinical practice [19][20][21][22][23][24][25] .…”

“…Francis et al [22] conducted a consensus agreement from 207 colorectal surgeons across 18 countries including 52 TaTME specialists. They recommended that prerequisites to learn TaTME should include 3 factors: the trainee, the mentor, and the training facility.…”