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

Abstract

Background

The 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.

Methods

A 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.

Results

Appropriate 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.

Conclusions

A 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.

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Acknowledgements

International TaTME Educational Collaborative Group: Aigner F, Albert M, Araujo SE, Arezzo A, Arnold S, Atallah S, Austin R, Biebl M, Bonjer J, Boni L, Bordeianou L, Brunner W, Cahill R, Davies RJ, DeChaisemartin C, Dapri G, de Lacy FB, Delrio P, Dzhumabaev K, Fernández-Hevia M, Hahnloser D, Heriot A, Houben B, Horgan AF, Jiménez Toscano M, Katory M, Kneist W, Knol J, Lacy AM, Lezoche E, Mamedli ZZ, Martin-Perez B, Mattacheo A, Maykel JA, Mendes R, Merrie A, Miles A, Muratore A, Nassif GJ, O’Perez R, Panis Y, Pfeffer F, Rasulov AO, Ris F, Rossi G, Rouanet P, São Julião GP, Seitinger G, Sietses C, Simó-Fernández V, Spinelli A, Sylla P, Steele R, Stevenson AR, Tanis P, Tavella O, Tsai A, Tuech JJ, Tuynman JB, Van Nieuwenhove Y, Vorburger S, Weiss H, Wolthuis A, Wynn G, Zorron R.

Funding

The TaTME educational workshop in Bristol was funded by an educational Grant from the Olympus Medical (OKMEXP00001988) but had no input on the contents of the workshop or the study.

Author information

Correspondence to Nader Francis.

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Disclosures

Marta Penna—Marta Penna’s clinical research post is funded by the Oxford Colon Cancer Trust (Occtopus). Nader Francis, Hugh Mackenzie, Fiona Carter, Roel Hompes and International TaTME Educational Collaborative Group have no conflict of interest or financial ties to disclose.

Additional information

Members of International TaTME Educational Collaborative Group are listed in Acknowledgements.

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Francis, N., Penna, M., Mackenzie, H. et al. Consensus on structured training curriculum for transanal total mesorectal excision (TaTME). Surg Endosc 31, 2711–2719 (2017). https://doi.org/10.1007/s00464-017-5562-5

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Keywords

  • Transanal
  • TME
  • Consensus
  • Training
  • Curriculum
  • Assessment