Transanal Total Mesorectal Excision Assisted by Laparoscopy

  • María Fernández-Hevia
  • Jean-Sébastien Trépanier
  • F. Borja de Lacy
  • Antonio M. LacyEmail author
Part of the Springer Surgery Atlas Series book series (SPRISURGERY)


Transanal total mesorectal excision (TaTME) is one of the newest developments in rectal cancer treatment. It has gained popularity in recent years not only because of the novelty of the surgical approach but also because it tries to resolve old problems associated with rectal surgery. The main advantages of this approach are that the distal margin may be chosen under direct vision, and it allows better visualisation during lower pelvic dissection.

The main indications are low to mid rectal cancer and patients with unfavourable anatomy, but they have been extended to include high rectal cancer and other pathologies. One of the noticeable differences when TaTME is compared with laparoscopy or open surgery is the reduced working space and the almost parallel position of the instruments but as the dissection progresses “down-to-up”, the surgeon gains more space and a better view. Also, the anterior-side dissection is easier from below, particularly in obese patients and those with a narrow pelvis. TaTME represents a new approach to performing an old technique.


Rectal cancer Transanal TME TaTME Down-to-up 


  1. 1.
    Miles WE. A method of performing abdomino-perineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon (1908). CA Cancer J Clin. 1971;21:361–4.CrossRefGoogle Scholar
  2. 2.
    Emhoff IA, Lee GC, Sylla P. Transanal colorectal resection using natural orifice transluminal endoscopic surgery (NOTES). Dig Endosc. 2014;26(Suppl 1):29–42.CrossRefGoogle Scholar
  3. 3.
    Heald RJ. A new approach to rectal cancer. Br J Hosp Med. 1979;22:277–81.PubMedGoogle Scholar
  4. 4.
    Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005;365:1718–26.CrossRefGoogle Scholar
  5. 5.
    Kang SB, Park JW, Jeong SY, Nam BH, Choi HS, Kim DW, et al. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol. 2010;11:637–45.CrossRefGoogle Scholar
  6. 6.
    van der Pas MH, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WC, Bonjer HJ. Colorectal cancer laparoscopic or open resection II (COLOR II) study group. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol. 2013;14:210–8.CrossRefGoogle Scholar
  7. 7.
    Buess G, Theiss R, Gunther M, Hutterer F, Pichlmaier H. Transanal endoscopic microsurgery. Leber Magen Darm. 1985;15:271–9.PubMedGoogle Scholar
  8. 8.
    Franklin ME Jr, Ramos R, Rosenthal D, Schuessler W. Laparoscopic colonic procedures. World J Surg. 1993;17:51–6.CrossRefGoogle Scholar
  9. 9.
    Knol J, D’Hondt M, Dozois EJ, Vanden Boer J, Malisse P. Laparoscopic-assisted sigmoidectomy with transanal specimen extraction: a bridge to NOTES? Tech Coloproctol. 2009;13:65–8.CrossRefGoogle Scholar
  10. 10.
    Whiteford MH, Denk PM, Swamstrom LL. Feasibility of radical sigmoid colectomy performed as natural orifice transluminal endoscopic surgery (NOTES) using transanal endoscopic microsurgery. Surg Endosc. 2007;21:1870–4.CrossRefGoogle Scholar
  11. 11.
    Diana M, Wall J, Costantino F, D’agostino J, Leroy J, Marescaux J. Transanal extraction of the specimen during laparoscopic colectomy. Color Dis. 2011;13(Suppl 7):23–7.CrossRefGoogle Scholar
  12. 12.
    Franklin ME, Liang S, Russek K. Natural orifice specimen extraction in laparoscopic colorectal surgery: transanal and transvaginal approaches. Tech Coloproctol. 2013;17:S63–7.CrossRefGoogle Scholar
  13. 13.
    Marks J, Mizrahi B, Dalane S, Nweze I, Marks G. Laparoscopic transanal abdominal transanal resection with sphincter preservation for rectal cancer in the distal 3 cm of the rectum after neoadjuvant therapy. Surg Endosc. 2010;24:2700–7.CrossRefGoogle Scholar
  14. 14.
    Denost Q, Adam JP, Rullier A, Buscail E, Laurent C, Rullier E. Perineal transanal approach: a new standard for laparoscopic sphincter-saving resection in low rectal cancer, a randomized trial. Ann Surg. 2014;260:993–9.CrossRefGoogle Scholar
  15. 15.
    Sylla P, Rattner DW, Delgado S, Lacy AM. NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc. 2010;24:1205–10.CrossRefGoogle Scholar
  16. 16.
    Lacy AM, Rattner DW, Adelsdorfer C, Tasende MM, Fernández M, Delgado S, et al. Transanal natural orifice transluminal endoscopic surgery (NOTES) rectal resection: “down-to-up” total mesorectal excision (TME)--short-term outcomes in the first 20 cases. Surg Endosc. 2013;27:3165–72.CrossRefGoogle Scholar
  17. 17.
    Rouanet P, Mourregot A, Azar CC, Carrere S, Gutowski M, Quenet F, et al. Transanal endoscopic proctectomy: an innovative procedure for difficult resection of rectal tumors in men with narrow pelvis. Dis Colon Rectum. 2013;56:408–15.CrossRefGoogle Scholar
  18. 18.
    Atallah S, Martin-Perez B, Albert M, deBeche-Adams T, Nassif G, Hunter L, Larach S. Transanal minimally invasive surgery for total mesorectal excision (TAMIS-TME): results and experience with the first 20 patients undergoing curative-intent rectal cancer surgery at a single institution. Tech Coloproctol. 2014;18:473–80.CrossRefGoogle Scholar
  19. 19.
    Velthuis S, Nieuwenhuis DH, Ruijter TE, Cuesta MA, Bonjer HJ, Sietses C. Transanal versus traditional laparoscopic total mesorectal excision for rectal carcinoma. Surg Endosc. 2014;28:3494–9.CrossRefGoogle Scholar
  20. 20.
    Fernández-Hevia M, Delgado S, Castells A, Tasende M, Momblan D, Díaz del Gobbo G, et al. Transanal total mesorectal excision in rectal cancer: short-term outcomes in comparison with laparoscopic surgery. Ann Surg. 2015;261:221–7.CrossRefGoogle Scholar
  21. 21.
    Muratore A, Mellano A, Marsanic P, De Simone M. Transanal total mesorectal excision (taTME) for cancer located in the lower rectum: short- and mid-term results. Eur J Surg Oncol. 2015;41:478–83.CrossRefGoogle Scholar
  22. 22.
    Tuech JJ, Karoui M, Lelong B, De Chaisemartin C, Bridoux V, Manceau G, et al. A step toward NOTES total mesorectal excision for rectal cancer: endoscopic transanal proctectomy. Ann Surg. 2015;261:228–33.CrossRefGoogle Scholar
  23. 23.
    Leroy J, Barry BD, Melani A, Mutter D, Marescaux J. No-scar transanal total mesorectal excision: the last step to pure NOTES for colorectal surgery. JAMA Surg. 2013;148:226–30. discussion 231CrossRefGoogle Scholar
  24. 24.
    Chouillard E, Chahine E, Khoury G, Vinson-Bonnet B, Gumbs A, Azoulay D, Abdalla E. NOTES total mesorectal excision (TME) for patients with rectal neoplasia: a preliminary experience. Surg Endosc. 2014;28:3150–7.CrossRefGoogle Scholar
  25. 25.
    Wagner OJ, Hagen M, Kurmann A, Horgan S, Candinas D, Vorburger SA. Three-dimensional vision enhances task performance independently of the surgical method. Surg Endosc. 2012;26:2961–8.CrossRefGoogle Scholar
  26. 26.
    Storz P, Buess GF, Kunert W, Kirschniak A. 3D HD versus 2D HD: surgical task efficiency in standardised phantom tasks. Surg Endosc. 2012;26:1454–60.CrossRefGoogle Scholar
  27. 27.
    Rullier E, Denost Q, Vendrely V, Rullier A, Laurent C. Low rectal cancer: classification and standardization of surgery. Dis Colon Rectum. 2013;56:560–7.CrossRefGoogle Scholar
  28. 28.
    Parks AG, Perey JP. Resection and sutured colo-anal anastomosis for rectal carcinoma. Br J Surg. 1982;69:301–4.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • María Fernández-Hevia
    • 1
  • Jean-Sébastien Trépanier
    • 2
  • F. Borja de Lacy
    • 1
  • Antonio M. Lacy
    • 1
    • 3
    Email author
  1. 1.Gastrointestinal Surgery DepartmentInstitute of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic of BarcelonaBarcelonaSpain
  2. 2.General Surgery DepartmentHôpital Maisonneuve-RosemontMontréalCanada
  3. 3.School of Medicine, University of BarcelonaBarcelonaSpain

Personalised recommendations