Transanal Total Mesorectal Excision Assisted by Laparoscopy
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.
KeywordsRectal cancer Transanal TME TaTME Down-to-up
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