Trans‐anal total mesorectal excision – reflections on the introduction of a new procedure

Bokey, Les; Zhang, M.; Fingerhut, Abe; Dent, Owen F.; Chapuis, Pierre

doi:10.1111/codi.15190

Cited by 5 publications

(3 citation statements)

References 61 publications

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“…According to a worldwide registry, TaTME has been adopted by several colorectal surgeons and has been implemented in more than 30 countries (7). However, the lack of proficiency with the bottom-up approach and the long learning curve of the TaTME technique have been held responsible for some adverse events (8,9), which have led to severe criticism (10), the moratorium in Norway (11), as well as a "pause" recommended by the Association of Coloproctology of Great Britain and Ireland (12). Specialized curriculums have grown throughout the world in countries such as the Netherlands, the UK, Australia, and North America as early as 2014 (13)(14)(15)(16), designed to facilitate the safe and widespread implementation of the TaTME technique.…”

Section: Introductionmentioning

confidence: 99%

Structured training curriculums for transanal total mesorectal excision in China: refinement is needed

Xu¹,

Cai²,

Zhang³

et al. 2022

Ann Transl Med

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Background: Transanal total mesorectal excision (TaTME) is an alternative for mid-low rectal cancer. In China, this procedure has been performed in high-volume centers with structured training curriculums. The efficacy of the TaTME structured training curriculums in China is still unclear. This multicenter study aimed to explore the effectiveness of the structured training curriculums in China.Methods: Seven high-volume centers in China participated in this study. The first 25 patients who underwent TaTME in each center were enrolled. In the cohort, patients were divided into 3 groups. The first 5 procedures (group 1) were performed under proctoring according to the requirement of structured training curriculums. The latter 20 cases without proctoring were split into 2 groups (10 cases in each group, groups 2 and 3) according to the order of operation date. The baseline characteristics, perioperative complications, and pathological outcomes were compared between groups 1 and 2, as well as between groups 2 and 3.Results: Symptomatic anastomotic leakage (AL) occurred in 18.6% of the patients in group 2 compared with 5.7% in group 1 (P 1 =0.08) and 5.0% in group 3 (P 2 =0.04). Seven (11.3%) patients in group 2 developed defecation disorders whereas no patients had this complication in group 3 (P 2 =0.02). Compared with group 2, the operative time was shorter (235 vs. 223 min, P 2 =0.40), while the rates of intraoperative complications (15.7% vs. 5.7%, P 2 =0.10), postoperative complications (31.3% vs. 25.7%, P 2 =0.06), AL (20.0% vs. 8.6%, P 2 =0.04), and positive distal resection margin (DRM) (7.5% vs. 2.9%, P 2 =0.27) were lower in group 3. Conclusions:The effect of the structured training curriculums was acceptable but needed further improvement. The prevalence of anastomosis-related complications and the quality control of specimens are still not optimal, and measures for refinement (for example, more cases under proctoring) are needed in the

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Section: Introductionmentioning

confidence: 99%

Structured training curriculums for transanal total mesorectal excision in China: refinement is needed

Xu¹,

Cai²,

Zhang³

et al. 2022

Ann Transl Med

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“…4 In minimally invasive colorectal surgery, the published NOTES procedure cannot be performed without the assistance of transabdominal ports when using the transvaginal 5 or transanal approach. 6 For example, in the German registry study, all colorectal procedures, including right colectomy and sigmoidectomy, required two to three 5 mm trocars to provide transabdominal assistance. 5 The broad utilization of the NOTES technique was hampered by a lack of easy-to-use instruments and a long learning curve.…”

mentioning

confidence: 99%

Short‐term outcomes of pure transvaginal laparoscopic right colectomy: A novel surgery approach based on an Idea, Development, Exploration, Assessment, Long‐term framework stage IIa study

Xiao

Chen

et al. 2021

Journal of Surgical Oncology

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Background and Objectives: The application of pure natural orifice translumenal endoscopic surgery (NOTES) to intra-abdominal visceral resections remains limited due to the complexity of the dissection. This study aimed to assess the safety and feasibility of laparoscopic right colectomy using a purely transvaginal approach.Methods: The data of 12 continuous patients with colon neoplasia who underwent transvaginal right colectomy from November 2018 to July 2020 were prospectively collected, and their perioperative events were recorded.Results: The patients' median age was 70.4 years. Four were diagnosed with colon adenoma and eight with adenocarcinoma. The median operative time was 185 min, with a median blood loss of 25 ml. The median time to gas passing was 32.5 h after surgery. The median postoperative hospital stay was 6 days. One operation was converted to hybrid NOTES due to difficulty with the anastomosis, and one was converted to laparoscopic surgery because of vascular injury. Three cases were grades I, II, and III according to the Clavien-Dindo classification. Conclusion:Pure NOTES right colectomy using the transvaginal approach is feasible and safe with good short-term outcomes. We recommend this novel technique for highly-selected patients with no more than a D2 dissection performed by experienced colorectal surgeons.

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“…Indeed, there are numerous examples of the quality and depth of knowledge that already exist and are unsurpassed in the classic 19th century descriptions of regional anatomy 14 though sadly these are often misunderstood, misconstrued, unknown or lost in translation 15,16 . Nonetheless, such descriptive details remain the gold standard 17 , and when further researched and confirmed may have a profound influence on the uptake of new surgical techniques 18 and patient outcomes 19 . In addition, Saniotis and Henneberg 11 remind us that anatomical variants are not rare singular instances, but rather evolving biological consequences requiring a response and the need to adapt to a constantly changing environment with its subtle influence on morphology relevant to surgery.…”

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confidence: 99%

Is a little anatomy sufficient or is a little more too much?

Chapuis

2021

ANZ Journal of Surgery

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Trans‐anal total mesorectal excision – reflections on the introduction of a new procedure

Cited by 5 publications

References 61 publications

Structured training curriculums for transanal total mesorectal excision in China: refinement is needed

Structured training curriculums for transanal total mesorectal excision in China: refinement is needed

Short‐term outcomes of pure transvaginal laparoscopic right colectomy: A novel surgery approach based on an Idea, Development, Exploration, Assessment, Long‐term framework stage IIa study

Is a little anatomy sufficient or is a little more too much?

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