Operating Theater Setup and Two-Team Coordination

Abstract

Transanal total mesorectal excision (taTME) can be performed by a single-team or a two-team approach. Potential advantages of two-team taTME include faster operative time and fewer conversions to open surgery. Key components of two-team taTME are operating room setup of multiple surgical platforms to allow simultaneous surgery without interference with one another. In two-team taTME, the abdominal team performs the abdominal colon mobilization and upper part of the TME dissection, whereas the transanal team performs the distal rectal transection and mobilization. Coordination of the key steps in taTME surgery is critical to allow for smooth operative flow. One of the critical points during two-team taTME is at the “rendezvous” between the abdominal and transanal dissection where the two dissection planes meet. Here, the abdominal team can retract and expose the rectum to allow the transanal team to carry the dissection forward and vice versa until the rectum is fully dismounted. The rectum may often be removed transanally and anastomosis performed by the transanal team, while the abdominal team performs an ileostomy. In this chapter, the details of operating room setup and coordination between teams for successful taTME surgery in cancer and benign disease are discussed.