Updates in Surgery

, Volume 71, Issue 1, pp 29–37 | Cite as

Transanal total mesorectal excision (TaTME): current status and future perspectives

  • Andrea VignaliEmail author
  • Ugo Elmore
  • Marco Milone
  • Riccardo Rosati
Review Article


Total mesorectal excision (TME) is the gold standard surgical treatment for mid- and low rectal cancer; however, it is associated with specific technical hurdles. Transanal TME (TaTME) is a new procedure developed to overcome these difficulties, through an enhanced visualization of the dissection plane. This potentially could result in a more accurate distal dissection with a lower rate of positive circumferential resection margins, increasing the rate of sphincter-saving procedures. The indications for TaTME are currently expanding, despite not being yet standardized, and structured training programs are ongoing to help overcome the steep learning curve related to the technique. The procedure is feasible and safe with similar intraoperative complications and readmission rates when compared with conventional open or laparoscopic TME. Favorable short-term oncologic results have been reported: in particular, TaTME is associated with mesorectal specimen of a better quality and a longer distal resection margin that is established at the beginning of the procedure under direct view. Robotics, when available, will probably overcome the steep learning curve related to the complexity of TaTME. Long-term follow-up and ongoing RCT trials data are awaited regarding functional results, local recurrence and survival, and to facilitate the comparison with standard laparoscopic or robotic rectal resections. The present review is focused on critically analyzing the theoretical benefits and risks of the procedure, its indications, short- and long-term results and future direction in the application of TaTME.


Rectal cancer Total mesorectal excision (TME) Transanal total mesorectal excision TaTME Robotics 



A special thanks goes to Francesca Aleotti MD for her precious help in linguistic reviewing and redrafting the manuscript.

Compliance with ethical standards

Conflict of interest

All authors mentioned in this study do not have any competing interest. This specific report does not endorse any specific Company.

Research involving human participants and/or animals

This article does not contain any studies with animals performed by any of the authors.

Informed consent

The informed consent does not apply since this is a meta-analysis study.


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Copyright information

© Italian Society of Surgery (SIC) 2019

Authors and Affiliations

  1. 1.Department of SurgerySan Raffaele Hospital and San Raffaele Vita-Salute UniversityMilanItaly
  2. 2.Department of Surgical SpecialtiesNephrology University “Federico II” of NaplesNaplesItaly

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