Transanal total mesorectal excision (taTME) in a single-surgeon setting: refinements of the technique during the learning phase

Caycedo‐Marulanda, Antonio; Ma, Grace; Jiang, Han

doi:10.1007/s10151-018-1812-3

Cited by 11 publications

(18 citation statements)

References 36 publications

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“…A brief description of our previously published surgical technique [20]. Prior to surgery, all patients receive mechanical bowel preparation.…”

Section: Surgical Techniquementioning

confidence: 99%

Experience beyond the learning curve of transanal total mesorectal excision (taTME) and its effect on the incidence of anastomotic leak

Caycedo‐Marulanda

2020

Tech Coloproctol

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Background The most important advancement in the surgical management of rectal cancer has been the introduction of total mesorectal excision (TME). Technical limitations to approaching mid and distal lesions remain. The recently described transanal TME makes it possible to minimize some of the difficulties by improving access. Anastomotic leak is a persistent concern after colorectal surgery no matter what technique is used. The objective of this study was to explore the impact of experience on the incidence of anastomotic leak after transanal TME. Secondary endpoints were local recurrence and margin status. Methods A retrospective cohort study was conducted over a period of 3 years at a tertiary care center in Northern Ontario with high volume of rectal cancer patients. The initial 100 consecutive patients with rectal neoplasia who had transanal TME surgery were included. All cases were performed by a single team. The main outcome assessed was the incidence of anastomotic leak beyond a pre-determined learning curve, as previously established in the literature. For statistical analysis, associations between patient characteristics and outcomes were estimated using ordinary least squares and logistic regression. Results Six cases of anastomotic leak occurred over the course of the study, the last of which occurred in the 37th patient. Relative to a baseline anastomotic leak rate of 7.8%, cumulative sum (CUSUM) analysis indicated that a 50% improvement in risk occurred at trial 50 of 85 patients that had an anastomosis performed. Two patients developed local recurrence during the study period. No correlation between learning curve and oncologic outcomes was identified. Conclusions Proficiency is likely to have a positive effect on the 30-day occurrence of anastomotic leak. Larger studies are required to explore the impact of experience on local recurrence.

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“…A brief description of our previously published surgical technique [20]. Prior to surgery, all patients receive mechanical bowel preparation.…”

Section: Surgical Techniquementioning

confidence: 99%

Experience beyond the learning curve of transanal total mesorectal excision (taTME) and its effect on the incidence of anastomotic leak

Caycedo‐Marulanda

2020

Tech Coloproctol

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“…87 Caycedo-Marulanda et al described the development of a systematic approach in the single-surgeon setting, comparing 27 early experience patients with 43 late experience patients. 88 There was no mortality or significant difference cohorts in terms of morbidity, anastomotic leak, operating time, length of stay, negative margin rate, or incomplete specimens obtained. Technical challenges experienced in this setting were not obstacles for safety, and improvement tended to occur with experience.…”

Section: Introduction To Transanal Tmementioning

confidence: 80%

“…Technical challenges experienced in this setting were not obstacles for safety, and improvement tended to occur with experience. 88…”

Section: Introduction To Transanal Tmementioning

confidence: 99%

Education and Training in Transanal Endoscopic Surgery and Transanal Total Mesorectal Excision

Keller

Lacy

Hompes

2021

Clin Colon Rectal Surg

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There is a paradigm shift in surgical training, and new tool and technology are being used to facilitate mastery of the content and technical skills. The transanal procedures for rectal cancer—transanal endoscopic surgery (TES) and transanal total mesorectal excision (TaTME)—have a distinct learning curve for competence in the procedures, and require special training for familiarity with the “bottom-up” anatomy, procedural risks, and managing complex cases. These procedures have been models for structured education and training, using multimodal tools, to ensure safe implementation of TES and TaTME into clinical practice. The goal of this work was to review the current state of surgical education, the introduction and learning curve of the TES and TaTME procedures, and the established and future models for education of the transanal procedures for rectal cancer.

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“…3). Der Ein-Team-Ansatz ist momentan häufig alternativlos [33]. Im eigenen Vorgehen kam das potenziell zeitsparendere Arbeiten mit 2 Teams bisher in 22 % zur Anwendung.…”

Section: Die Ersten Fälleunclassified

Transanale totale mesorektale Exzision – Voraussetzungen zur sicheren Implementierung

Kneist

2019

Zentralbl Chir

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ZusammenfassungDie transanale totale mesorektale Exzision (TaTME) ist eine innovative und technisch anspruchsvolle Methode zur chirurgischen Behandlung des Rektumkarzinoms. Ziel dieses Artikels ist es, die Voraussetzungen und Trainingsbedingungen darzustellen, die für die sichere Implementierung dieses komplexen Verfahrens entscheidend sind. Die internationalen Expertenmeinungen werden vor dem Hintergrund der veröffentlichten Ergebnisse aus TaTME-Schulungszentren diskutiert. Darüber hinaus werden eigene Erfahrungen aus den TaTME-Anatomiekursen (Video) und einer ersten klinischen Serie von 102 TaTMEs mitgeteilt. Das Verfahren sollte in erster Linie von kolorektal spezialisierten Fachärzten für Chirurgie durchgeführt werden. Zunächst ist aber ein strukturiertes Schulungsprogramm an ausgewiesenen Aus- und Weiterbildungszentren obligatorisch. Ein Training am Körperspender und ein Proctoring für die ersten klinischen Fälle sind für eine sichere Implementierung der TaTME erforderlich. Die TaTME-Schulungskonzepte müssen weiterhin validiert werden. Die statistischen Auswertungen erster Fallserien deuten auf Lernphasen hin, die mindestens 40 Operationen umfassen. Hiernach werden niedrigere Komplikationsraten und eine akzeptable TME-Qualität erreicht. Auch in vorliegender Fallserie nahm die Morbidität nach > 40 Fällen signifikant ab (Clavien-Dindo ≥ III: 29 vs. 9%). Die Indikation wird bei besonders hohem Risiko (Median: 6 Risikofaktoren, Streubreite: 4 – 8) für ungenügende TME-Qualität und kritisch eingeschränkte Funktionalität gestellt. Für High-Volume-Zentren mit einer Konzentration von entsprechend selektierten Patienten wird eine TaTME-Frequenz von 20 pro Jahr empfohlen. Strukturierte Schulungsprogramme für TaTME sind notwendig und sollen vor der Einführung in die Klinik durchlaufen werden. Der Case-Volume-Effekt und die individualisierte Indikation führen zur Konzentration der Methode an spezialisierten Zentren.

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Transanal total mesorectal excision (taTME) in a single-surgeon setting: refinements of the technique during the learning phase

Cited by 11 publications

References 36 publications

Experience beyond the learning curve of transanal total mesorectal excision (taTME) and its effect on the incidence of anastomotic leak

Experience beyond the learning curve of transanal total mesorectal excision (taTME) and its effect on the incidence of anastomotic leak

Education and Training in Transanal Endoscopic Surgery and Transanal Total Mesorectal Excision

Transanale totale mesorektale Exzision – Voraussetzungen zur sicheren Implementierung

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